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P�.RMIT APPLICATI�.N <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRE5S PARCEL TAX I.D.A� PE MIT M � <br /> ,2ooa Ne�V�itt ����u� � �(la -Oa5 <br /> LEGA LOTNO. BLOCK TRACT <br /> D'cSC. <br /> OWNER AODRESS CITY2IP PHONE <br /> �`��� `'� �"�`t� zoov �1e�u�H �A�e n ue �v�e re-t+ q82o� '� 25�322.2l�5z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��tl� �2us� sra�e (�uss o' S�, Nz5- Zio- 552y <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> S�i'YLOVv1LD �Gv1S�1'UGiI1Uu � 0�1 �-� sh�x,�IttSV_rc��' Mqn,js�l� ,��5_3y�,_ 5�3�1 <br /> CONTR.LICENS � � �N� �{g2� <br /> � v -o�-�- �31� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Strorr� Cu:41125.� <br /> Cp��yl�tP� ��a,� �C.Q r�lA"�- X Electric Gas Other Knr�4GkGlasSt91���•00 <br /> — — — �:a <br /> WORKDESCRIPTION I�3��S i)Removc. D�y�4�1 1NStp1 91aSS StofrffoNt <br /> Kf�rLTAKG�S " I�I�TA� :)GuF ti�foUbhp�"��I �N Bp�k wPll to hav�Acces> }o <br /> iaqv2 �wy 9�s,� � scme storct�„¢ sppte <br /> .�a,�ci t,�i+ ya fi f � <br /> PLUMBING MECHANICAL <br /> NO. TYP@ OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet AIC—air handling units <br /> Bathmb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Ciothes washer Clothes dryer <br /> _ Laundry tray _ Range hood <br /> Sink(servicelbadmopletc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinai Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Reftigeration <br /> Grease trap _ Woodstove <br /> I _ Roo(drains _ Olher <br /> Olher <br /> � <br /> � CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby centify that I have read and examined this applicaUon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granUng of a permit does not presume <br /> � to give authonry to violate or cancel the provision of any other state or local law regulatlng consWction or the perfortnance of <br /> � construction.That I am uthorized 6y the owner of this property to perform the work for which applicaUon is made and I comply wilh the <br /> State Contr� 8.27 RCW and 296.200 WAC. <br /> � /Z-/ _O <br /> Sign t r o r�Contracior/Authonzed Agent Date <br /> i / 1/Z I <br /> � <br />