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P�tRMIT APPLICATI�N <br /> C'ITY OF EVERETT PERIM�T SERVICES <br /> 3200 CEDAR STREET, EVE�ic.'(T,WA 982Q1 <br /> 425-257-8810— F,4X 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTE� FROM 8 AM TO 4 PM ((�0 50fr-O y�) <br /> SITE ADDRESS ���Z O��'J PARCEL TAX I.D.q PERMIT# <br /> 3 Do5�7�-D� <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ���� A�'�� CITY2IP C�Z.�^��_� �[��//f11��-J����- <br /> �7�'. ��_„,�_1+�a ��iQ:�� V�i� �-�n� �IG�� <br /> TENANT NAME �,�p CONTACT FOR PER T PHONE <br /> �YIE. AS �`lY <br /> CONTRACTOR ^ ��`�.^'tAODRESS p�Q� 12_�. CITY2IP PHONE �zQ� <br /> ��\ <br /> CONTR.LICENSE p ' �'^L��O�q � " ' o � �pp�`�����l �y� � <br /> W V l — �F17�I-<Yf,tp�7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �I� ��� _Eleclric _Gas_Other �2 "�J��.�,�� <br /> WORK DESCRIPTION �e�� � � � <br /> C�' ��w�-���v► � v�e��rre-� be w,wrr.d. <br /> � s��f� �dr�� �i��r�,e. �. ae���. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink 6 disposat Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes wa<_her Clolhes dryer <br /> Laundry tray _ Ranc�e hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> Backilow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigoration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this applicalion and know Ihe same lo be Irue and correcl. All provisions of laws and <br /> ordinaces goveming this lypo of work will be complied wilh whelher specified herein or noL The granling of a permit does nol presume <br /> to give aulhonly lo violate or cancel the provision of any other slalo or local law rogulating conslruclion or the performance of <br /> conslruclion.Thal I am authorized by lhe owner of this properly lo pedorm lhe work for which application�s made and I comply with lhe <br /> Slato Conl lors Law 18.27 RCW and 296.200 WAC. <br /> pi � <br /> Signature o(Owned onlractor/Au iorized Ac�ent Dale <br />