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In -� � ` D7 <br /> ; � <br /> 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 ACCEP'ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL�AX I.D.N P RMIT i{ <br /> �116 ►�aci�c /�Ve �U7�0 -�03 <br /> LEG1, LOT ND. BLOCK TRACT OR SUBDIVISION fl <br /> DESC. <br /> OWNER ADORESS CINlZIP PHONE <br /> � �N'1 � ,�V�rc'1� <br /> TENANT NANE CONTACT FOR PERMIT PMONE 3�,� 305 q I 96 <br /> �VW�+h Qe�ol�r�QS �w��c �e�pv E�MAIL <br /> CONfhA R A D 5 � � �/ '\ <br /> � I hv�nD,U � 3 �o„s{v�a�s �`43G /-�-{,.r�.t- Dr. 13e1�irrj�+ei.+� �"�J <br /> CONTR.LICEN ll wQ, R�]Z� 7�- �'66 <br /> �7i,�w�o g C o 6� KA <br /> USE OF BUILDING HEAT SOURCE I �ONTRACT PRICE OF WORK <br /> pFG�GeS �y�Z�j- � <br /> �'� ���s _Eledric _Gas_Othcr I J �� � — <br /> WORKDESCRIPTION ���v �x��� P�.UuK��vu� !N) wN_ �w S�`��C 4� �"'"b <br /> �orlct v1�al2r 1� �e �L;�rc-�^e�n , Y��� N�11G Cuol.iKj U���S �N f�"n5 1�1�1►� <br /> (�ebc4�r ,�"�isfi� GRds ,},.,� AcL� I nkw C6�1� uN�� -te (� 117 �4n�, v��e to Ale�v GP.�' oh <br /> PLUMBING MECHP.NICAL QQ Gili� <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIKTURE OR!TEM <br /> Toilet A/C-air handling unils <br /> f3athlub Forced air systems <br /> i_;vatory(wash basin) _ C,as piping <br /> Shower V.�ater heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer Clolhes dryer <br /> Watr.n c�ater Range hood <br /> 1 Sink(service/barlmop/elc.) _ Exhaust fan <br /> 6ackflow preventer _ Heat pump <br /> Urinal Unit nealer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove / / <br /> Roof drains � Olher (��T� L�v[. �'s�N�/����� <br /> \ Olher 1.�g_ tf _ - <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify lhal I ha✓e read and examined Ihis application and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether spec�lied herein or noL The yi anting of a permit does nol presume <br /> to give authority to viola6�or cancel Ihe provision of any other stale or local law regulaling coneLvction or the per(ormance ot <br /> construclion, Thal I am authorized by!he owner o(this properly to periorm the work(or which appecation is made and I comply with the <br /> Slate C�ctors Law tE1.27 RCVJ and 296.200 WAC <br /> /D 15�� <br /> .._- <br /> Signalure o1 Owne� d dhorized Agent Date � <br /> \� <br />