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F cRMI�' APF'LICATIvN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org � O/�/ 3—OOZ <br /> APPLICATIOMS ARE A(:CEPTED FROM 8 AM TO 4 PM � � a '-'D / <br /> SITE ADDRESS P:4RCEL TAX I.D.# ERMIT# <br /> 1 �/ ��_�vc✓c o 3fi'5Z�f'� OZZOO _�� _ <br /> ILEGAL LOT N . BLOCK TRACT OR S7BDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PI10Nc <br /> � 7�1}'G , <br /> �L.��- /3 Zo f*o��_ E,.a-rct-� W 1`� `1 t 5- Z 31- 9 z.!g <br /> TENANT NAME I CONTACT FOR PFRh71T PHONE <br /> � (Jf,C,nC�(1�'1 iJu�-�l✓!�] E•MAIL yzS ' 35 I ' �D�o7Z. <br /> CONTRACTOR ADDRESS �--� CITYIZIP PHONE <br /> �(�oZ - S7$ - �`t!� yas•35`!-��yL <br /> CONTR.LICEIISE# / <br /> —L',_G�Lll���k��ic_ � 4Z2.1 s� g3o h1� �-r�;K�Ea�. v� `�tz3 <br /> USE OF 6UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> G.�Y�r — _Eleclric _Gas_Gther JZ 7n�' � <br /> WORK DESCRIPTION <br /> ... ' i'1�Y—=yt:-or�C�IT'� . << , <br /> �� � �J . � ✓ti''� L-� +��2` ,1 .34X1� <br /> c <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIKTURE OR ITEM <br /> Tuilet F✓C—air handling units <br /> B:��hlub Forced air sys�ems <br /> Lavatory (�vash basin) Gas piping <br /> Shower Waler heater <br /> Kilchi�n sinh& disposal _ Gas lireplace <br /> Dishwashcr Gasranye <br /> Clothcs washcr Clolhes drycr <br /> Waler heater Ranye hood <br /> Sink(scrvice/bar/mup/�tc.) Exhausl tan <br /> Backfluw preventer Hca�pump <br /> Urinal Unil heatcr <br /> Drinking Pounlain Boiler <br /> Floor drain Re(riqeration <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3 i05 <br /> I hereby cerilify that I liave n:ad and examined lhis application and know the same b bo lrue and correcl. All provisions of laws and <br /> Iordmaces governing lhis lype ol work will be complied with whelher specified herein or nol The granling of 2 permil does not presume <br /> to give au�hori�y lo violalc or cancel lhe provision ot�ny olher sl2le or local law rec�ulating cons�ruclion or the performance of <br /> jconslruclion. ihal I :mi aulhorized by the owner of this property to perlorm the worV:lor which applicalion is made and I cumply with Ihe i <br /> ; Slale Conlraclors L��v 18.27 RCW and 296.ZUU WAC. �� <br /> II �_� 3 — y-c�`I <br /> Signature of Ownev actorlAulhorized A�en� Dale <br /> � <br />