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P�RMIT APF`LICA�ION <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 S�: PARCEL TAX(I.D.# ` PERMIT# � <br /> I�l2 �S - -���� T = ��i C��t��"15321'E�71 I G� h�1 � �.�� - :��� �� <br /> LEGA LOT NO. BLOCK TRACT OR SUB�fViSION tl <br /> D[SC. <br /> OWNER ADDFE55 CITYIZIP PHONEtt2S' �'�-��SLL' <br /> ���-11 I � St��aia���r S�ir�r>ifr:�� - ;'a���- z��tr�J� F�e���r l�'-��l <br /> TENANTNAM.E CONTACTFORPERMI PNONE r <br /> I Q Z�'-SU�" E'� 1i5 <br /> F ^„ „.. <br /> �J��1 N I�7��1'J< < � E•MAIL <br /> ONTRA i' R . � � A t S ITY/ZIP P E <br /> � S � =flri�� �- �c,u/79Y- 73r� <br /> l-/� � - — '►1i91�J '_ q � I/�� � <br /> CONTR.LICENSF#C�f���l �'�C��� �i��I��. �6`� �� SI , ��IU'I�IWE'� ��2� Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ___Electric ,�Gas_Other �� ,3 t�c�/% — <br /> k <br /> WORK DESCRIPTION <br /> f � l!Z �C� �J i)+i�ikJ �1�"� /9 �)l� D /�� J�, F�(i��l�'� �;/1,�'� eCr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> 9alhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br />� Backflow preventer � Heat pump <br /> Urinal Unit healer <br /> Orinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woc.lstove <br /> Roof drains Other_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7'WS <br /> I hereby certify that I have reai'and examined this application and know the same to be true and correct. All provisions of la��+s and <br /> ordinances governiny this type ot work will be complied with whether specifed herein or ncl The grantino of a permit dces not presume <br /> to give aulhority to v�olate or cancel ihe provision of any other state or local law regulating construction or the pertormance of <br /> consiraclion. That I am authorized by the owner of this property to pedorm the work for wl•�.ich appliwlion is made and I comply wiP,the <br /> St2te Contractors Law.18 27 R .uV and 296200 WAC. <br /> I 1 l �[� G,1� ��I I �"7C'I C� <br /> Sic�natu e of Own ntraclodAut onzed Agent ate <br /> � <br />