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P�RMIT' APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,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.# PERN{LT# <br /> ��28 No`(T AvEnlvf. 00�'1532`1 �0190� �-,- �� / � � ��,`— <br /> LEGA LOT NO. BLOCK TRACT OR SUODIVISION il <br /> oesc. SEE 4d7. Al,l Z4 n•oo Lo75 �q zo <br /> OWNER AODRESS CITY2IP PHONE <br /> pFl►�!p � S7EP�larJ� S=�`PhIE�1S /�231�oY7 avE . E�E4Ett �f$2ol '�2S,t5"i,�l5�� <br /> TENANTNAME CONTACTFORPERMIT PHONE �.Lg ��Q '�allO <br /> l <br /> �A tw�En.'t R.'66� J e-r.,a�tzeee�.t�nK�� <br /> �ONTRACTOR AUDRESS —��T� � PHONEA1t ITQrL:t�GI <br /> '7E BE S�s.1c7Et7�� �Gt,S�)i„ �P�,�o�� L��S �/ � ��'� �� ��P� <br /> CONTR.LICEIJSE# <br /> USE OF�BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �t�t��.E F/01'all`� QFSIpG1�T'�Ql. I _Electric �Gas_Olher ��p p00 <br /> WORK DESCRIPTION <br /> Anoi�/p/� oF S�FI 4F df uw��5 SPAc6 � N6i•�l FRorJT Po�t.tF,l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 2 Toilet �, A/C—air handling unils <br /> Balhlub �_ Forced air systems <br /> � Lavalory(wash basin) �j I Gas piping <br /> I Shower _ Water healer <br /> � Kilchen sink&disposal _ Gas fireplWcc <br /> � Dishwasher Gas rang� <br /> ! Clolhes washer I Clothes dryer � <br /> Watcr hoaler � I Range hood <br /> _L Sink(service(bar/mop/etc.) ' �� Ezhausl fan �!i <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Founta`n _ Bniler <br /> Floor drain Re(rigeralion <br /> Greasetrap _ Woodslove <br /> Roo(drajns _ Other_ <br /> �_L -�IhrrFo3t—e.tn� — . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriUfy lhat I have read 2nd examined Ihis applicaGon and know lhe same lo be true and wrtecl A�I provisions o(laws and <br /> ordlnaces goveming this type ot work��vill be complied with whelher specified herein or noL The granting of a permit does not presume <br /> lo give aulhority lo violale or cancel lhe provision of any nlher stale or local law regulating conslruction or the performance of <br /> consUuction.That am aulhorized by lhe owner of this pmperty lo per(orm Ihe work tor which application is made and I comply wilh the <br /> Slate Cont lor L w 1827 RCW and 2962DO l4'AC. <br /> !L,/Z,�b <br /> Siy ature of Own onlractodAuthorized Agent Date / <br /> �1.`of.f2T RE60� �1�TI•�ere.�ZEO A��T `( � <br />