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i - <br /> PtRMIT APPLICAT'IUN <br /> CITY OF �VERETT PERMlT SERVICES <br /> 3200 CEDAR STREET. EVERETT, VJA 98201 <br /> 425-257-8810— FAX 425-257-8857—ww��.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � ��j�� � <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> �2��� nb� c�.,� �.,�R"T y�,�. Moc�o�--�a�-I <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CIN/ZIP PHONE <br /> ��Fa �lcCc..��'',� Z2c�1 jao� P�vE ���c:�t 94s+-�� Nzs3--�cd.�hz. <br /> TENANT NAME CONTACT FOR PERMIT PHO4E <br /> ���. �P�-+ �G.G..'�-�P,K +1�5 3a�$ N.�2 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> �/7S3ip� OHoC <br /> CONTR.LICENSE p �����r�C�L�M� p� p <br /> y.il'f, z�23 �"CN61Ai j1'� �l � /�Z� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric�Gas_Other p "' — <br /> � 9 00, - <br /> WORK DESCRIPTION <br /> �TSLt�Zta�� C-�c�S t'.��+-�-��� S4S"C£N�. � <br /> PLUA781NG MECHANICAL I <br /> NO. NPE OF FI%TURE OR iTEM NU. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> _ Balhlub � Forced air systems I <br /> Lavalory (wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwashcr Gas range <br /> I _ Clothes washer _ Clolhes dryer <br /> Watcr healer Range hood <br /> I _ Sink(service/badmop/etc.) _ Exhausl�an <br /> I _ Backllow preventer Heat pump <br /> Urinal ^ Unil healer <br /> Drinkinc� Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> � _ Roof drains _ Other_ <br /> � Olher <br /> I I — — — – <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> �i , I hereby ceritily ihal I have rezd and examined ihis applicalion and kr�ow the same to be true and correct. All provisions of laws and <br /> �� � ordinaces goveming lhis type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> ilo give authority to violate or cancel the provision of any other state or local law rec�ulatinr� construction or the per(ormance of <br /> conslruction.That I a rized by the owner of this property to perform the work for wh;ch applicalion is made and I comply with the <br /> State ntr plors Lai 18.27 CW and 296.200 WAC. <br /> �..�` �,.A.,x.c�-� �72-5 cb <br /> SignaWre o OwnedContr� tor/Authorized Agent Date <br /> -- � <br />