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i <br /> PtRMIT APPLICATION <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.# ERMIT N <br /> 70 3 0 �v-�r,��c ,o/�. 3 2�00 �c�o i o a— 7b3 - �5 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE 2�6 <br /> d.�Yoiv �l�,�'cc,9 ATT,r2.�7e'�y 7030 o�Y.���c oQ. c��'r f'�JZv3 yy8-,�zo7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E2i.C� C f/�'✓SEN yzr-�s-� �-Zz,, <br /> CONTRACTOR ,�.G,��(�NS�"A//1[`iH00�4N(�DRESS CITY2IP PHONE <br /> f' �Fai2 �/.J37 FoRr;1i D2. Ev6hE`Tl y�s=ZJ'g-Z�/l <br /> CONTR.LICENSE M <br /> ,E�CNAnic// y6 Yo S� 98�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> cS%NC4�F/1M���/!%•"SiOfN�'A< �( Electdc _Gas_Olher ��6y� s <br /> �`"1' <br /> WURK DESCRIPTION Cr�M��l • UN/t/N/ � <br /> C �f.4QJ f�/rJ�on� Of'l�iQSc�MENj' � v <br /> 0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toitet A/C—air handlinp units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) Gas pipfng <br /> Shower �, Waterheater <br /> Kilchen sink�disposal Gas fireplace � <br /> Dishwasher Gas range � ^ � <br /> Clolhes washer Cbthes dryer � <br /> � Water heater _ Ranga hood J �(,1� <br /> _ Sink(service/barlmop/otc.) _ Exhausl fan Ip �,rt�— <br /> Backflow preventer Heal pump „(J�ki' <br /> Urinal Unil heater <br /> Drinking Fountain Baller <br /> Floor drain Refrigerat(on <br /> Greaso trap Woodstove <br /> Roof drains Othor <br /> Other <br /> � / <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 7105 <br /> I hereby ceritify that I have road and examined this applicalion and know the same W be We and cotrect. All provislons of laws and <br /> ordinacas goveming lhis lype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to gfve authority ro violate or cancel lhe provision of any other state or local law regulatinp construcdon or the performance of <br /> construction.That I authorizad by tho owner of this property ta perfortn the work far which applicatlon is made and I comply with the <br /> Stale Conlra a �i��d 296200 WAC. / <br /> � .�/ o� <br /> Signa of OwnerlCo r crodAuUiorized Agent Da�e — �/Z <br />