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PE:F�MIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982�1 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICA'rIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEI TAX I.D.# PERMIT# <br /> �l15 � ��'T �c�. �.29300 7cYJ I��1 "10"1 �Z� <br /> LEGA! LOT NO. OLOCK TRACT OR SUAOIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TANGT �Gll�y lyl5 If�'Yi�'►� c✓�� %��OI yZ5-L5k ��lSr�, <br /> TENANTIJAME CONTACTFORPERMIT PHONE <br /> B�t�,� �Oeu� yas M?s-��1�•y� <br /> Dr1Y d-N�fE P�m,�G— d-HTC-r �lc��n/�/ 13.� .�c�P.GGI, ��cyyN�Nc��cb� PHONE <br /> CONTR.LICENSE# �A,�NrPtto�lyern ' '^'�/ �`J ����'��� <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � r— <br /> _Electric �Gas_Other J/ ��� <br /> WORK DESCRIPTION <br /> �Ff'cr9cE �xIST1,.�G C�s i�G,f2nN�F-� CtJi7N- .cJ2Gc� <br /> � t,.r11�? �1�NsF�E � ��� [�/��L��� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> f3athWb � Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower VJater healer <br /> Ki;chen sink&c sposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes drycr <br /> Water healer _ Ran�e hood <br /> Sink(service/bar/mop/etc.) Ezhaust fan � <br /> Backtlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drin!cing Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Greasetrap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> II <br /> CIN CP EVERETT LOCAL SALES TN(CODE IS 3105 I <br /> I hereby ceritify that I have read and examined ihis application and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming lhis lype of work wiil he complied with�•�helher speci(ied herein or nol The granting o`a permil does not presume <br /> to yive authority lo violate or cancel Ihe provision o(any other stale or locai law regulating construction or the per(ormance of <br /> construclion.Thal I am aulhorized by the own-r oi this property to perform the work for which application is made and I comply wilh the <br /> State C �ractors Law 18. CW nd 00 AC. <br /> 2 �� ���� <br /> Sig e wner/CcnlractorlAut rize . . Dale <br />