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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM U d�j0�f-(j�{L <br /> SITE ADDRESS ��Z,Z- �cS PARCEL TA%I.D.# PERMIT# <br /> D a <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE S CITY2IP ��P�E�� <br /> �ii�o.11�i���Y�CCT 17',�p �t�1 clo <br /> ��.. � .f_ �� <br /> �.'�J�'�L �u'x1�'�' �1�Rse�'I- 1...�1 9' ?� I)�{,a(�� <br /> TENANT NAME CONTACT FOR PERMIT <br /> �q{y1� i�S�(/�'��1�. I <br /> CONTRACTOR r" �- �DDRESS p�Q� � CITY2IP PHONE �Z� <br /> 1�Y �,� � t�Y�ltslr( ''�°< <3 <br /> CONTR.LICENSE# � ,� p� ���QS�C� G`��Rt„�_G�(�G� <br /> V Vf�+–�" <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /.t2�.lyy,h► �^�lt��`v-'�-- I _Eledric _Gas_Olher #'��j C��-� <br /> ���� ...—. . <br /> WORK DESCRIPTION �e�� � O�'� .• <br /> Q Facw�la-ftan ' v���rre�' be w,�rr.�e�J. <br /> S� (E �dw,�� �v� � �'��. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> A/C–air handling units <br /> _ Toilet Forced air systems <br /> _ �alhlub Gas piping <br /> Lavatory(wash basin) — yyaler heater <br /> _ Shower Gasfireplace <br /> _ I<ilchen sink&disposat — Gas range <br /> _ Dishwasher Clolhes dryer <br /> _ Clolhes washer Ranc�e hood <br /> Laundry tray Exhausl fan <br /> _ Sink(service/bar/mop/elc.) Heat pump <br /> _ BackOow prevenler Unil healer <br /> _ Urinal Boiler <br /> _ Drinking Fountain Re(rigeralion <br /> Floordrain Woodslove <br /> Greaso trap — Other <br /> Roof drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined Ihis application and know the same to be true and cortecL All provisions of laws and <br /> lo g ve au ho ity to 9iotlate oP cancelr lie Ip ovis on olf any oltl er stale or�local awr egulafing`construcGon or�lhe pe olrmance of Presume <br /> construction.That I am aulhorized by tho owner oi lhis property to pedorm the work tor which application Is made and I comply with lhe <br /> State Con ctors Law 18.27 R W and 29G.200 WAC. <br /> � . $�� <br /> SignaW o o( w ConlractorlAu iorized Agent Dale <br />