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i <br /> PtRMIT APPLICATIC�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 PARCEL Tl�.:I.D.# % PERMIT N <br /> ���7 ��'�°�� C�%'�i 57 S I7 oc�Soc�:) .D nGO�I-�C 3 <br /> LEGAL LOT NO.q BLOCK TRApC T <br /> DESC. (3 V l �� 6�✓ P�V f l PL�T " � <br /> OWNER ADDRESS � CITY2IP PHONE <br /> �'�Q �G,Ut" �f"/'(� /y � �C� (�:Vl�ll � ��r ,71y�- ��St.17/ �'� YZS -Z� � `�Np�� <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> I Jr'1 iiV C��OI�,vC.IGq �-r ZS���Z- (Y�, � <br /> CONTRACTOR P�L� � V d (�.2. ADDRESS CITY2IP PHONE <br /> P�O� �°K IL3ZG <br /> CONTR.LICENSE# � YZ��—�1 Z��Y� � <br /> P�'`�Et7G !'j!o Z U G <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> SINCLC '�+Q"�h /�6 . I <br /> �Eiectric _Gas Other �j�R"d <br /> WORK DESCRIPT�ON <br /> p.f n•,o C_,r�� C� ttf�-��� /��'LJ G��iE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYpE OF FIXTURE OR ITEM <br /> _ Toilet AIC—air handling units <br /> _ Bathlub Forced air systoms <br /> _ Lavalory(wash basin) Gas piping <br /> _ Shower Waler heater <br /> _ Kilchen sink&disposal Gas fireplace I <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clothes dryer <br /> _ Waler he�ter Rango hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> _ Backllow prevenler Heat pump <br /> _ Urinal Unil heater <br /> _ Drinking Fountain Boiler <br /> � _ Floor drain Rofrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3705 <br /> I hereby cerilify thal I have read and examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether sp,,cified herein or�o(.The granting ot a permit does nol presume <br /> to give authority to violate or cancel the provision of any other state or Iocai iaw regulaling constructlon or the pedormance of <br /> construction.Thal I am authorized by lhe owner of this property to perform lhe work for which applicalion is made and I comply with the <br /> Stale C�`�`�'��s�f.aw-i�7 RCW and 296.200 WAC. <br /> \�=�-�.-�" �--- �l- 7 W �,i <br /> Signature ner Cahlractor/Authonzed Agent Date <br />