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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � 3� �co�r �v�. ���r���.�Z��� , �� �,� � �'�-I <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. y � °i S.uFr "Z LZ� Me,—,��e-�� �>0 �-o ,� ����2 �f--; I <br /> OWNER ADDRESS CITY2IP PHONE Z�� � � <br /> G���J� , WPJ;tt� lls'l �-to�'r !�'v� ��v: 9�?G<< Z7� �;�� ; <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> oWi�ttci2 �JcFitil ot,clLS����!n �'�25 Ls'L i�lf� � <br /> CONTRACTOR < � ADDRESS CIN/ZIP PHONE � S <br /> t�Rs� P�%r�i tt�'� a�-.�r �{v. 30}� t Z 7.'L �Z <br /> �x �'crv Sr�o��no� �N ``1hZ�'�- <br /> CONTR.LICENSE# �'L l�(d L <br /> (��o Oy0 L`96 Z n C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � r� _Eleclric �Gas_Olher <br /> WORK DESCRIPTION �� <br /> Z.�tV �-ro�2� ADo�rr�•.� AivJ ;'r.o,as��_� ..S <br /> PLUMBING MECHANICAL <br /> NO. lYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> �_ Toilel _ A/C—airhandlingunils <br /> Balhtub Forced air syste�ms <br /> �_ Lavatory(wash basin) Gas piping <br /> _L Shower _ Waler healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Ranga hood <br /> Sink(servicelbadmop/etc.) � Exhaust fan <br /> 8ackflow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re(rigeralion <br /> Grease hap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether speci(ied herein or nol.The granting of a permit does not presume <br /> to give authority lo violate or cancei lhe provision of any olher stale or local law regul2ting construclion or the peAormance of <br /> conslruction.That I am authorized by the owner of this property to per(orm the work for which application is made and I comply wilh the <br /> Slate Co ors . W and 296.200 WAC. <br /> , i-I-��-o� <br /> Signature vner/Co t�ctorlAuthonzed Agent Date �/ 1 <br /> l <br />