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�- <br /> P`tRMIT APPLICATI�N <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 /> APPLICATIOP:S ARE ACCEPTED FROM 8 AM TO 4 PM ��_S/ <br /> SITE ADDRESS I 3�,Q OA� PARCEL TAX I.D.# P MIT p <br /> I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER Gb� .��„c_` ADi;E�S CITY2IP P E <br /> t �••srf -�-v�l�� 1 ;i0 ��Z�o� �'•� <br /> �7_l�'��.�e-LTL�, �.1RoR.'�1?�. � � Zi�'„ 1v(�� 1� <br /> TENANT NAME I CONTAC.!FOR PER T PHONE <br /> �Atk1E. esS p�.Cr`l!� <br /> CONTRACTOR � ��4DORESS�7 O f2_�, CITV2IP PHONE (� � <br /> CONTR.LICENSE# ' , L�'/�0�� �}�"l, ���\ �r�YX1tSl�{ x�� <br /> V��,G•1 r�r Qt p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �JI�-�`1 ����� I _Eleclric _Gas_Other �� S �� <br /> WORK DESCRIPTION �e�� � � � <br /> �. F�la-ka� • v�es�erre� be w,�rr.al. <br /> q S� (� �d�,�� ge�� �1 a�'�G <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FI%TURE OR IiEM <br /> _ Toilet \ r� _ A/C—air handling unils <br /> _ Balhtub ,,� `' _ Forcedairsystems <br /> _ Lavatory(wash basin) ,�(� _ Gas piping <br /> _ Shower nr� Water healer <br /> _ Kilchen sink&disposal �\ �1i _ Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer � � _ Clolhes dryer <br /> _ Laundry lray 1� ' Range hood <br /> Sink(servicc/badmop/etc.) Exhaust(an <br /> _ Backflow preven�er Heal pump <br /> Urinal Unit heater <br /> �rinkinc� Founlain Boiler <br /> _ Floor drain Refrigeralion <br /> Greaso trep Woudstove <br /> Roof dralns Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces govemir.g Ihis lype o(work will be complied with whelher specified herein or noL The granling of a permit does nol presume <br /> to give authonty to violate or cancel lhe provision of any other state or local law regulating consfruction or lhe perfortnance of <br /> construction That I am authorized by the owner oi this property to perform the work for which application Is made and I comply with the <br /> Slale Con ctors Law 18.27 RCW and 296200 WAC. <br /> � <br /> Signalu of w e ConlraclodAul o ized Agenl Date <br />