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F�RMiT APPLICATI�N <br /> CITY OF EVFRETT PERM�T SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereNwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 6 AM TO 4 PM -DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �I�{ PARCEL TAX I.D.t PERMIT• <br /> /O v� �(,/! Lc�i U1 — U 1''1 <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � OV ��u� ��Q OI2L <br /> TENANT NAME � CONTACT PERMR Pf10NE <br /> . 2�P�y S �-e{�° fli��ll �QL° 2td' 3a�f/ <br /> CONTRACTOR ��,f� ADDRESS CRY21P PIIONE <br /> /V � <br /> CONTR.LICENSE t <br /> USE O ,BUILDING � I — HEAT SOURCE CO T PRICE OF WORK <br /> a � �/� <br /> �� 'r � ElecMc vGas Other fW <br /> WORK DESCRIPTION I �� �'� � � V �� f//VI'C �'l� I ,�'/� CT� <br /> G�.��=�- /��`iz-s�e ��'1✓L G,4v� � /d�f��-s/Z., <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%7URE OR ITEM NO. TYPE OF FDRURE OR Il'EM <br /> Toilet A/C—air handlirp units <br /> Bathtub Foraad air systems <br /> Lavalory(wash basin) Ges piping <br /> S;iower Water heater <br /> _ h'itchen sink 8 disposai _ Gas Breplece <br /> _ Dishwasher Gaerange <br /> Clothes washer Gothea dryer <br /> Laundry Uay Ranpe hood <br /> Sink(service/bar/mop/etc.) E#�aust han <br /> Backflow preventer Heat pump <br /> Urinal Unk heater <br /> Drinking Founfain Bofler <br /> Floar drain Refigeradon <br /> _ Grease lrap / (` Woodstove <br /> Roo(drains � Tr�o ,�+ �'/aaY J/kK� — �er <br /> � Other � <br /> CITY OF EVERETT LOCAL SALES 7A7(CODE 19 7105 <br /> I hereby ceritify that I have read and examined this applicaUon and know the same to be Uue and correct. All provlelons of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not The granting of a pertnft does not presume <br /> to give authoriry to violate or cancel the�+rovision of any other state or local law regulaGng constructlon or the performence of <br /> construction.That I am authorized by the owner of lhis propertv io pe�!ortn the work for which applicatlon is made and I comply with the <br /> State Contractors Law 18.27 R and 296.200 W � <br /> i �� ��� <br /> Signature of OwnerA.ontractor/ uthorized Agent te <br />