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Y - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEi2VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> S�TE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /�eo i�/ovsrn sr -a�o F - s�� a o��o 00 o�.soa i�✓l �� ° - <br /> L[GA� LOTNO. BLOCK TRACT I <br /> I DESC. <br /> OWNER AD�RESS CITYIZIP PHONE <br /> ?�4�ro,r. �������.� i6y� �.��� w,�y T"k��,l�a 9�r� <br /> 7ENANT NAME I CONTACT FOR PERMIT� Sam Mill�r PHONE:425-885•9100 <br /> I <br /> CONTRACTOR:Unlvorsal Machanical Sorvico AD�RESS:P.O.Box 2649 CITYIZIP:Rntlmond,WA 98073 PHONE:C25-885-9100 <br /> CONTR.LICEIJSEp UNIVEMS112JF <br /> USE OF BUILDING HEAT SOURCE CONTRACT'RICE OF WORK <br /> Y �' <br /> OFF/CE /�9�fi��SF _Electric �Gas_Other /;Z� qpo — <br /> WORK D SCRIPTIOM1 ,L,.� ��F��� Ex�,n�- � Tjp�� �,ys�rr�!S <br /> lrlS/ACG 7Heff�3/U•�/T�+r���i <br /> PLUMBING MECHANICAL � <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toilet _ A/C-air handling units I <br /> Balhtub Foroed air systems � <br /> Lavatory(wash basin) _� Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> C�ahwasher Gasrange <br /> Cbthes washer � Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) / Exhausl fan <br /> BackOcw preventer Heat pdmp <br /> Urinal �� Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LCCAL SALES TAX CODE IS 3105 <br /> I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws a.�d <br /> ordinaces goveming this type of work will be complied with whether specifed herein or not. The gren6ng of a permit does not presume <br /> to give authority to violate or canc i tha�rovision of any other state or local law regulating construction or the performance of <br /> construction That I am author' d by�fie owner of this property to perform the work for which appliwtion is made and I comply with the <br /> Stale Contractors Law 78. R �nd 296.200 WAG. <br /> — � -� �T 9/S � <br /> Signature of Owry dCoglraclor/Aulhonzetl Agent� ate <br /> / �/Z <br /> ry <br />