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f <br /> �-- -- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 38201 <br /> 425-257-8810- FAX 425-257-8657 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � - � '� �D 6 � <br /> � <br /> SITE AD�RESS PARCEL TAX I.D.# MIT# <br /> /�, � <br /> I.�GY� D ' �C�na.Wo T ��� O Gi� 0 3-..$CO CY G y � <br /> LEGAL LO"lNO. BLOCK TRACT <br /> �t�^ <br /> OWI:�R ADORESS CITY/ZIP PHONE <br /> rlQ o�li �r�t��a����/r �6�i'�D.�ivsusF.t/r�2� r,rw�,�,/(� If�/�S <br /> TENANT NAME CONTACT FOR PERMIT: Sam Mlllnr PHONE:425-885•9100 <br /> ,G"G �o�i�-00 � <br /> CONTRACTOR: Univ�rsal Mnchanlcai Sorvlco AODRESS:P.O.Box 2649 CITVIZIP:Rudmond WA 98073 PHONE:425-885-91U0 <br /> CONTR.LICENSE# UNIVEM57J2JF <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> J�Electric X Gas_Other ����f�.3�� <br /> i aNE(�1-reiJ aNF() S-rc✓✓, an�f J 2SnW� • c�;F JS-7oN /i41 ElECm�G <br /> WORK DESCRIPTION dSr9l� ' o �i�f�J / <br /> �.cPre�P Y.9cK.rF�f G:viT w�7ff 1Ssorn47'f racrs, c s,,.�,qs P..�E, /.uJl.S�Z� <br /> <.vEII ✓.4✓ F.re/ T�`"n.yi.v� w�nr �irl�� N�.f-J; /.Nlr.vs< f.�/r� fxrFwsr/v�,.�n�.rnro,� �.�.�s <br /> �✓inr.4Ssoci.o rf D�nr3 d y'F�iu6. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathiub � Forced air systems <br /> L:3vatory(wa.�h basin) � Gas piping <br /> Shower Water heater <br /> Kdchen smk F. iisposal Gas fireptace <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mopletc.) _S Exhausl(an <br /> Backfiow preventer Heat pump <br /> i Unnal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woudslove <br /> Foof drains I Other_�/A7/ Fqrl TE12�1/Nq'L <br /> Other <br /> GTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this application and know the same to be true and correct. All provi,inns of laws and <br /> ordinacf�s govemirg this type of work will be complied with whether speciled herein or not.The granling of a permil does not presume <br /> to give.wthority to violate or cancel the provision of any o;her slate or local law regulating consiruclion or the performance ot <br /> Iconslruc6on. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the I <br /> State CoNrectors.�8.27 RCW and 296200 WAC. � � <br /> _�,.� '/°_� 1 � I <br /> Sign�1G of OwnedContractor/Authorized Agent / ate �L <br /> , <br /> � <br />