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PERIVIIT APPLICAI �ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> -- - --- 425�St=88'tU=FAX-435=257-8857---wNnrr:e�erettwa:org — <br /> pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I PARCEL TAX I.D.# I PERMIT# <br /> SITE ADDRESS /� L �� �;��. � _ � .C.�_� <br /> .>��J =A�J:S'� J f l✓C- J r e !t�••J <br /> LEG LOTNO. BLOCK TRACT <br /> DES�. <br /> AQORE:S CINIZIP PHONE <br /> OWNER <br /> TENANT NA�dE <br /> I CONTACTFORPERMIT PHONE <br /> /� J�.� t � F� �'c.� `'I Z S 7�c�:. `. L.Z ;1y <br /> ����J I'1�L'S F��Cx PHONE _ <br /> ADDRESS CITYZP . vJ.., r� <br /> CONTRACTOR Sy��.. 5 t�o ., ;�� -� f�. ,'�,.�n y,7•�j 7 '�tZ1� �J' <br /> �U.�: i-hu.�•'ir fft.n�l�^,j ' <br /> CONTR.LICENSE!f <br /> !v.p(�"t'H L-> H L�7S J F CONTRACT PRICE OF WORK <br /> USE 6F BUILDING I HEAT SOlIRCE <br /> C/ � � <br /> �� ` .,� „_ `_ _Electric _Gas_Other 4�9 ,�� � � <br /> W•t< <br /> ' WORK DESCRIPTION <br /> y^��+-" � � F, �, .�:{� <br /> PLUMBING MECHANICAL <br /> TYPE OF FIXTl1RE OR ITEM17 NO. TYPE OF FIXTURE OR ITEM <br /> NO.� — <br /> A/C-air handling units <br /> Toiiet Forced air syslzms <br /> Bathtub '— Gas piping <br /> Lavatary(wasli basin) — Water heater <br /> Showar "— Gas firepiace <br /> � IGtchen sink&disposal — Gas range <br /> Dishwasher Clothes dryer <br /> ~ Clothzs v�asher — Range hood <br /> Laundry tray — 6chaust fan <br /> Sink(servicelbar/mop/etc.) — Heatpump <br /> 6ackflawpreventer —'- Unitheater <br /> Urinal — Boiler <br /> _ Drinking Fountain — Refrigeratlon <br /> FloorGrain — Wandstove <br /> Grease Vap — Other <br /> Roof drains —'— <br /> 0(f12f <br /> � I —_ <br /> '� I� - CITY OF EVERETT LOCAL SALES TAX CODC•IS 3105 <br /> �I — <br /> � i h�reby ceritify that I have read and examined this application and know the same to be We and wrtect. Ail provisions of laws and <br /> crdinaces goveming this type of work will be complied with whelher specified herein or not The grenGng of a pertnit does not presume <br /> � �� I to give authority to violate or cancel the provision of any other state or Iocai law reguiating wnshuclion or the pedortnance of <br /> � construction.That I am a thorized by the owner of lhis property to perfortn the wark for v�hich application is made and I comply with the <br /> State Contract Law 1 ZRGW and 296.200 WAC. <br /> � ( 3 <br /> Dae � <br /> ;ignature of Ovfie ContractadA orized Agent ��, <br /> l�. <br /> �� — <br />