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P�RMIT 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 ����' - �� <br /> SITE ADDRESS (?j Z'B �Li.�S PARCEL TAX I.D.# EF�RMIT# -� <br /> I 1/� <br /> [./.�L/ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ��.� A�I'E� CITY/ZIP C, F�7�� �^� <br /> �j�I��� �^+'+�a �YYeF• 1.� �Y ZF,t'o YY�(� GQ2lTlV1�[I <br /> TENANTNAME I CONTACTFQRP[R T PHONE I <br /> ��1� p5 €�y� <br /> CONTRACTOR � �—C�(,'�`�DDRESS p�Q � CITY2IP PHONE �Z�� <br /> ( �(�� • �Urb.YX11.S1-I � � <br /> CONTR.LICENSE A �L��,��,�q � pp..R��� <br /> 1 — �F� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �N �l� I _Electric _Gas_Other � �,���� <br /> WORK DESCRIPTION ��r� � �O�"� ,• <br /> � �� ' �s��erre� be ��l• �, <br /> q S� !� �d��t� �en��rr� a � <br /> PLU BING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathlub _ Forced air syslems <br /> _ Lavatory(wash basin) ' 1 � � _ Gas piping <br /> Shower � L _ Waterheater <br /> Kilchen sink 8 disposal Q � � _ Gas fireplace <br /> Dishwasher ' _ Gas range <br /> Uothes washer ( i ;�'� _ Clothes dryer <br /> Laundry lray �, , _ Range hood <br /> Sink(service/bar/mop/elc.) �i � _ Exhaust fan <br /> Backtlow prevenler �I ; ' _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Founlain _. Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof dr2ins _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TN(COUE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and kno�v Ihe same to be true and cortecL All provisions oi laws and <br /> ordinaces c�oveminc�this lype o(worl:will be complied with whether specified herein or noL The granling oi a permil does not presume <br /> lo give aulhorily lo violale or cancel the provision o(any other stale or lor,al law regulating construction or the pertormance of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which application is made and I comply wilh Ihe <br /> Stale Co actors Law 1827 RCW and 29G.200 WAC. <br /> � <br /> Signal o of wn / ordractorlAutho z d Agenl Date <br />