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P�tRMIT APPLICATIOiN <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,(050 �-0�I I <br /> SITE ADDRESS I3I Z� �---�5 PARCEL T D.# PERMIT p <br /> �S.✓Y.,2�25�� 1�OSC)�-Ol�' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �Q�����y��..�� �I'�` CITY2IP ��PF ��� �� <br /> '�-rrs� � <br /> �V ,�,�I _ <br /> �"�Il'.QI �'c r'�e 1�R.'E�"I' � ���1�- !i <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> �k►� fa.s �.(r`�� <br /> CONTRACTOR ^' ���DDRESS p�Q� �,y CITY2IP PHONE ��� <br /> a�c�� <br /> CONTR.UCENSE k '_ �^L�-�OS-d q • � �r�,`�_ � � <br /> �"�'• —t L' I zyno� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �N �l� I _Eiectric _Gas__Olher �ZJ �� <br /> WORKDESCRIPTION p���J � � ,� <br /> q F��v,�lafcar, • v�e��rre� 6e w,�rr�l. <br /> t�' s� �� Fd�,�t� g��+� Ik� a�'�G <br /> NLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM17 NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dish�vasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry trey _ Ranc�e hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> �ack(Iow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have read and examined lhis applicalion and know Ihe same lo be truo and correcL All provisions of laws and <br /> ordinaces goveming this type o(work�vill be complied wilh whether speci(ied herein or noL The granting of a permil does not presume <br /> lo give authority to violate or cancel the provision of any other state or local law reguialing construclion or lhe periortnance ot <br /> conslruction.That I am authorized by the owner of lhis property to pedorm the work tor which application is made and I comply with the <br /> Stale Co actors Law 1t3.27�W and 296.200 WAC. <br /> � <br /> Signat o ot wne onlraclor/Au orized Agant Date <br />