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F� �::RMIT APPLICATIvN <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 PARCEL TAX I.D.p PERMIT# <br /> � ,Es , oo�.�q 5��c� �Uo 7n.� 3� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY/ZIP PHONE <br /> Sn�Noir'1i5 N <br /> 1/i4r�n�E� Ec..�,oE-� Q3o5 15��-�Gts� �a-9D ���-`��a�� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � 6�.-y� 2���� yzs- ��5 �;y��/ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> DM' �-n/�Tr PimB� d-Nr6- ���/y �3.tr1 �r� w [.Y,v,vcc�c+�0 4z5_7�5-�o�/b�� <br /> CONTR.LICENSE N <br /> D�-Y�✓r�r��'vyc�n 9ko37 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Eleclric �Gas_Other �'3 5/y� �0�, <br /> WORK DESCRIPTION <br /> �EOl�4cE F.tiS�N� CTs►5 �a/�+t/sFCFs Gvl� �/��CJ <br /> �A5 �N�NACE � Lc�'.4TEv �l Gvf5F�1�'tPNT , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub �_ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes wasner Clolhes dryer <br /> Water heater Range hood <br /> Sink (service/bar/moplelc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking founlain _ Boiler <br /> Floor drain Relrigeration <br /> Grease lrap _ Woodstove <br /> Rool drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined this application and know the same to L•e true and correcl All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting of a permit does not presume <br /> � to give authonly to violale or cancel the provision o(any other stale or local law regulating construction or lhe per}ormance ot <br /> conslruction.That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br /> State Con clors Law 18.27 W nd 29 0 WAC. <br /> , � ���� �3-/9-07 <br /> Signature �vnedConlractor/Autl iz�k�rtF— Dale <br />