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PL.tMIT APPLICA�'I',��J <br /> CITY OF EVERETT PERMIT SEF2VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everett�va.org <br /> APPLICATIONS ARE ACCEPT!' � FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � (1, PARCEL TAX I.D.i� ERMIT i! <br /> q�3 No r v� oJ Do�f37o37 0 / �o J03'/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. ' 7� p���- o� £v6�pE7T D1V�,� 1oN $ <br /> OWNER �6 PcRo FT 5�3oR�s GR �EN L�-/cE �n/�)/ N P(HONE ��/O� <br /> �b$ �RT G� �` E�-��E7-7-3�� <br /> TENANT NAME I 'ONTACT FOR PERMIT PHORE <br /> I <br /> CONTRACTOR ADDRESS CI71f21P pHONE <br /> COYTR.LICENSE# <br /> US'c OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eieclric �Gas Other <br /> WORK DESCRIPTION <br /> D�I� o � � � H lfo�c ,� � <br /> PLUM3ING MECHANICAL <br /> NO. TY�E OF FIXTUR@ OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet A/C—air handling units <br /> Bathtub Ferced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposai Gas fireplaco <br /> 6ishwasher Gas rango <br /> Clolhos washer Clolhes dr}•er <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> EackOow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Cioiler <br /> �loor drain Refrigeralion <br /> Grease trap � Woodsteve <br /> F'nof drains Other <br /> Other — <br /> CITY OP EVERETT IOCAL SALES 7AX COOE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same lo be We and ce�ect. AI!provisions of laws and <br /> ordinaces governing lhis type of work will 6e complied wilh whelher specified herein or noi.The granting of a perrnit does:^ot p.:;sur�c <br /> to give authonty io violate or cancel the provision of any other stato or local law regulating consWction or the periorman;a of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I cromply wilh tlie <br /> Slate Co��27 W and 296.2Q0 W / // <br /> � 3 3 05 <br /> Signature of OwnedContractodA thorized ent Da� <br /> I <br />