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; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT i�`'�RMIT SERVICES <br /> 3200 CEDAR STREET, E��ERETT,WA 98201 <br /> 425-257-8810– FAX 425-257-8b57-�www.everettwa.org <br /> APPLICATIONR ARE ACCEPTED R40SA 8 AM TO 4 PM � —/� � <br /> SITE ADDqESS PARCEL T�X I.R.# PEFiM1T# <br /> �g t�+s; �,�c � �� A�� � D lOCJd5C�3 �. 0 � C �ZI <br /> LEGA LOT NO. OLOCK TRACT OR SUBDIVIS:ON p <br /> DESC. <br /> OWNER ADDRESS CITYR�P PHONE ��j <br /> ��lx�..� Gft�n�Es ��/, ��si �r,zc�7yAv� �'✓cnen"9k�'8 5/3-�(�70 <br /> TENANT NAME COr�NTACT FOR PERMIT PHONE�/7� ��5 / �G�, <br /> iJ�"7a*v ��-J`fUC�Gf�— E-MAIL f✓ <br /> CONTRACTOR AOORESS CITY2IP PHONE <br /> ,��r fi .�iT� P�m� d Nic. !C/l�l i3;�� ��Y,rti� �n�'NN- -1 / J/ <br /> CONTR.LICEtvSE ttni7 7�J QH ��I�I/�y1 �/�SV� / L� Z�" � /CJ'V`/�L/ <br /> [/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eleciric ___Gas__O�her <br /> WOflK DESCRIFTION <br /> Sn/s;/-��� ,� NPatJ DClLTLESS U�� i DG'C,�_ /{�10 <br /> �r�O c p2 fIEA'T �c��P S Y5 T�rL� <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTUFE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toile� __ A/C-airhandlingunils <br /> ____ BalhWb _ Forcedairsyslems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> _ _ Dishwasher _ Gas range <br /> __ Clothes washer _. Clothes dryer <br /> __ Waler heater _ Range hood <br /> _. Sink(service/barlmop/etc.) Ezhaus�fan <br /> ._ BacMlo�,v preventer ,_(_ Heal pump <br /> Urinal Unit heater <br /> _ Drinkin[� Fountain Boiler <br /> _.._ Floordrain _ Refrigeration <br /> _ . Greasetrap Woodstove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I <br /> I hereby ceritily thal I have read and examined this application and know ihe same to he�rue and correcl. All provisions ol laws and � <br /> ordinaces govern��,ng Uiis type of work wili be complied wllh whether specilied herein or noL The granting o(a permit does not presume <br /> to c�ive au�hority to violate or cancel Ihe provision ol any other stale or local law rec�ulaling constmction or the performance ol <br /> consiruction.Thal I am authorized by�he owner of this pmperty to pertorm Uie work for which applicalion is made and I comply with the <br /> State Conlractors Law 18.1?7 R aad 286200 WAC. � • ' <br /> ��'r�l�r.,. �C�-��� � ��/C�0�1 � <br /> Signa urv t OwnedContr ooA�'io gent Dat <br /> �------ - - -- <br />