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PEf'rMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE`f, EVERET?, ::'A 9o2U1 <br /> 425-257-8810- FAX 425-257-8857 -w�vw.everettwa.or3 <br /> APPI.�CATIONS ARE AGCEPTED FROM B AM TO 4 PM � _ ��j _ O7 <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT i! <br /> Z�U� ��G� �.�1(- ��)D 7(�� � ��.� <br /> LEGAL LOTNO. BLOCK TRACT <br /> D'cSC <br /> OWNER ADDRESS CITY/ZIP PHONE i(ZS-� <br /> ���`�N �t�al�pSor1 zlol I-�oY� zs:'-7zro <br /> T[NANTNAME CONTACTFORPERMIT PHONE <br /> / <br /> CONTRACTOR � v �Z�� `��RESS �� �Z��� CI�Y21P PHONE �z,S <br /> C�� �tz <br /> ' F�F�=Fzcf zss-77_56 <br /> CONTR,LICFNSE p �/�. Y O� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��'R�3� I _Elec�ric _Gas_Other �U�OC.(�j— � � �) <br /> WORK DESCRIPTION <br /> Cs�KSrnvc.Tlat.0 a� � z4 ��C34� (i-�� �IU?1�iE G-1�{tF1L� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITElA NO. NPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling unils <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas oiping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> I _ Dishwasher _ Gas range <br /> � Cblhes washer Clothes drycr <br /> Waier heater Range hood <br /> Sink(servica/badmoplatc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> I _ Urinal _ Unil hcaler <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> = Olher I — <br /> I I <br /> ��7Y OF EVERETT LOCAL SALES TAK:.ODE IS 9105 <br /> I hereby coriti(y thal I havo read and examined this application and know the same�o be lrue and correcl AU provisions of laws and , <br /> ordinacos govorning this typo of wvrk will be complied with whelher specified herein or noL The granling of a permit does not presume . <br /> lo give aulhoriry lo violate or cancel lhe provision of any other slate or local law regulatin9 conslruclion or the pedormance of ' <br /> Iconslruclion.Thal I am authori�ed by lhe owner of lhis properly lo pedorm the work for which application is made and I comply with Ihe I <br /> Sl� s Law itl. CW and)_96.'L00 WAC. i, <br /> I� s��>C� -� � '/ ��- <br /> ' Sic�nature of Qwnerl oNreclor/Authonzed A9enl Dato ' <br /> li 1/� <br />