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PCRMIT APPLICATI(��V <br /> CITY OF EVERETT PEF:MIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—Nnvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FF;OM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � I I -a-�� �� v U�I �b Z?� �1 �U �` �1'u-3 Lr' 6 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. (� '�2I 'IL- �ITS �(-�7��'�! �j?% � L=C'CS�� <br /> OWNER AUDRESS CIN21P PHONE t�?�3�7 c��(.3 <br /> Su��;� C��,��,� � v,��,.,,,� ��k�s�.� <br /> 1111 I-krT �� r�r�� �1�ZoJ <br /> TENANT NAME C7tlTACT FOR PERM�T PHONE <br /> i �i, o�so,�. 4Z� S�� �/��Z <br /> CONTRACTOR �,q�ir�c L�-Q�,/1{rt"S �'L ADORE55 CIN/ZIP PHONE <br /> Z7zL• P��ct� ,4-+� ruc�-� yzi � S9-/3�/ <br /> CONTR.LICENSE# �/�;Gjr�d> 6�i:��� S;�Zp� <br /> USE CF BUILDING HEAT SOUFCE CONTRACT PRICE OF WORK <br /> t �JNs R <br /> C.?Q/',f�CZ t- _Eleclric _Gas_Other � `ji �/� <br /> WORY.DESCRIPTION �.q <br /> /� / ^ l r -) j��i�l.�Q��CYU S�r �• � � � .� � , <br /> L.�) ...- n/,nJ C�r�ZL: Ctiti �''..'_/S% /�+(�. i �'G ' . . . <br /> 7 � �V l. rn / <br /> � Jv w <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR Il'EM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handlinc� units <br /> BalhWb Forced air systems <br /> Lavatory(wash basin) � _ Gas piping <br /> ShoH�er � Water heater �-' <br /> Kitchen sink&disposal _ Gas fireplace ; <br /> Dishwasher ���� Gas range . <br /> _ Clothes washer �' _ Cbthes drycr <br /> Water heater _ Range hood <br /> Sink(service/bar/rt16p/etc.) _ Ezhausl(an <br /> Backflow prevenR�r _ Heat pump <br /> Urinal � _ Unit heater <br /> � _ Drinking Fou tain _ Boiler <br /> _ Floor drain� _ �Re(rigeration <br /> Grease tr9p _ Woodstove <br /> Roo(drains _ Other _ _ <br /> Olher -- — <br /> CITY OF F.VERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify t'nat I have read and examined this application and know the same lo be true and corred. All provisions of laws and <br /> ordinzces governing this type of work will be compli�A witli wheiher speci(ied herein or noc.The graNing o(a permil does-not presumu <br /> lo give authority to violate or cancel the provision of any olher slale or local law. regulating consiruclion or the performance of <br /> construclion.That I am authorized by the owner of tY,�s property to per(crm the work(cr which�pplication is made and I comply with tha <br /> State Contraclors w 18.�7 R W and 296200 WAC. <br /> i �,,� 3/�z/a� �� <br /> ;� <br /> Signatu of OwnedConlractor/Authorized Ageni Date <br /> 7L � <br />