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� pER:MIT QPPLICATION 'I <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 42�257-8857—www.everettwa.org <br /> APPLICATIONS ARe ACCEPTED FROM B AM TO 4 PM � a�-- " -(�7 <br /> SfTE ADDRESS �(-� PARCEL TAX I.D.# PERMIT# --, �� <br /> 2 � , - 2 � � �� 4 -u � <br /> LEGAL LOTNO. BLOCK �CT , <br /> oEs�. � E � � n <br /> OWNER ADORESS CITYZP PHONE <br /> i��Or�h lio�1 �rn�o�fmonts, lLC P D. Rnx I<3�-ffrli n�1z�n �I�9K'12� �I�-�I�-�5�0 <br /> "fENANT NAME � � I CONTACT FOR PERMR PHONE <br /> � �enn�s �1r�qles�l�ar�-h �125-�34�-45(�2 <br /> CONTRACTOR n f OI�TI IUULW CUSI Qm Hv�TlP�AODRESS CITYILP PHONE <br /> I\, r �1 Qp? Pa. gox I30-�ri� 1�n,WA- 9�22"'7� 4Q ..�(�z �I,, <br /> CONTR LICENSE� �I OR I �Cfl I OcJC�_ � " 1 K�t..,�l J�JL <br /> IV I <br /> USE OF BUILDING HEAT SOIJRCE CONTRACT PRICE OF WOkK <br /> \j )� ��m� i �SI� �Electric �Gas_Other T'' S <br /> V UC W � I <br /> WORK D CRIPTION <br /> �/�x( ��ame �in�Cl� �a.mi '�sid�nc� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR REI'R <br /> %- Toiiet AIC–air handling units <br /> Bathtub � Forced air systems <br /> Lavatory(wash basin) Gas pi�ing <br /> Shower. � Waterheater <br /> � Kitchen sink&disposal Gas fireplacr. <br /> � Dishwasher Gasrange <br /> � Clotheswasher � Clothesdrye• <br /> Laundry tray � Range hood <br /> Sink(service/bar/mop/etc.) Fxhaust ian <br /> Backlio�v prevenler _ hieat pump � <br /> Ur�nal _ Unit heater <br /> Dr�nYing Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of vrork will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulating construdion or the performance of <br /> constructi .That I am authorizeci by the o�mer of this property tu perform the wor4;for which appliration is made and I comply wilh the <br /> Stat do 8 -R a 200 WAC. i <br /> � <br /> I Sg ture 0— o — uthon e gen al' ^ <br /> L ��l <br />