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�-ERMIT APPLICAT�UN � Im w� �� <br /> CITY OF EVERETT PERMIT SERVICES -p <br /> 3200 CEDAR STREET, EVERETT,WA 98201 DQ�D 1 G '(JS-� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> /D -3/- ob <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ��� - �/ <br /> SITE ADDRESS �� ��r � ��Z� /��� � PARCEL TAX I.D.A� PERMIT t <br /> F�v' ' �a�- <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONE 339`/vo� <br /> L�VErer=77 ��DuSI� iqN71{dQ�t 3i�17 �vL13/ Evi�CF77 �5lZW <br /> TENANT NAME CONTACT FOR PERMI7'� PHONE <br /> CONTItACTOR OG(/NP`l� ADDRE3S �Y1il Lz CITY2IP P110NE <br /> CONTR.LICENSE K <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �p S!I�c'Afllll�f�— IZp�/7�L Eleclric `Gas_Other y�G�(�� <br /> ��u 13LI t_ /�U�/5/ dJ�/ — <br /> WORK DESCRIPTION c� iXJ/�` S �lCf/C TuiCt� <br /> a u,�r �s i3u�e,�e� �z z� �ti�e,���.� , � <br /> �z�9 izovi` s7�Pv�ru�'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _�, Toilet _ A/C—air handling unils <br /> � Balhtub�si 1 o u--r't Forced air systems <br /> �_ Lavatory(wash basin) _ Gas piping <br /> Shower Wafer healer <br /> � Kilchen sink$,dia�eeel _ Gas fire� lace <br /> Dishwasher Gas range <br /> � Clolhes washer Clothes dryer <br /> � Water heater ✓ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal � Unit heater <br /> Drinking Fountain _ Boller <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5705 <br /> I hereby ceritify lhat t have read and examined this application and know the sarne to be true and cortect. All provislons of laws and <br /> ordinaces goveming this lype of work will be complied wilh whelher specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority to violate or cancel the provisic�i of any other state or local law regulating construc8on or the performance of <br /> construction.T t am authgrized by the owner of this property to perfortn the work for which application is made and I comply wlth the <br /> State Contr t L 18".37 RCW and 296200 WAC. <br /> ,/��,r.Gi�.r�' 9/rz!v(o <br /> Signature of OwnedConlraclor/Aulhorized Agent ate lL, <br /> �utir�ac7>���< 1�,�,�i5 � 339-i�X�' �,e C�— yaa - y� �z� �� <br />