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i <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERM <br /> �'�5 HEA e� QD. C.'OliOl�lC?OOd�-3�� ) " / <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> PnT���eir� 1-1�2,e�s 3�-15 HcAr�rE� ,C'n 9`�oE'-r =�a��.�Z a5�5� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> G�zcc, Ovc,z��,� �z5-soS-��s5`r <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> UnY� ��TL /�,���. �-i��� ���i�� �s-��. �v ��,�Na����n YZ5 �75-G�/�y <br /> CONTR.LICENSE# n pV�� <br /> / 0 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Other � ���-� <br /> WORK DESCRIPTION <br /> /���P�,�7cG /19�fi.� Gfi`fh7�,� SE��vic.E Tf'-�'>'�- Gr7'Y %)%�Z <br /> ( •� Tl-/E Hz'u�S�� :� <br /> P!_UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handling units <br /> Bathtub _ Forcedairsystems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clolhes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> � Other �{/A77-i? .5r'/'i�/C� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have�ead and examined this application and know lhe same lo be true and correct. Ail provisions of laws and <br /> ordinaces governing this lype o(work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give aulhoriry to violate oc cancel the provision of any other stale or local law regulating construction or lhe perfortnance of <br /> construclion.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slale C nUaclors Law 16.27 RCW an 200 WAC. <br /> l"`�/�lli t ���l�L% ��/IT�– 7�'��'�� <br /> Sign3tur t OwnedContractor/A horized Agent Date <br />