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P�RMIT 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 /> SfTE ADDRE55 PARCEL TA7(I.p.# PERMI7 A <br /> (40l � I.�K. ooE3�t co►oo I d�ao�-o!9 <br /> LEGA LOTNO, BLOCK TRACT ' <br /> DESC. �_ <br /> R ADDRE55 CITY2IP PHONE u2s� <br /> �F ��r��,r- �,� tg�o� 4��� w. S� a.� �.,�,°►�3v �,-9ayd. <br /> TENANTNAME CONTACTFORPERMIT VHONE <br /> ��. o�u�Prr�-r�r L P I P�,1 Co��vA� �}Zs= 37�a -w.a7 <br /> CONTRACTOR O�w� ���„_ L I� ADDRESS CITV2IP PHONE <br /> 11�71NY �,� �'$��. ��. � <br /> CONTR.LICENSE�1o�� �Q� �1iJyU.i� <br /> _� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> / ICW� v Eiechic _Gas_Other <br /> WORK DESCRlPTON <br /> Pwr�,� N�.W CA�rwU,�., `im,�.T���w <br /> PLUMBING M CHANICAL <br /> NO. 7YPE OF PIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �, Toitet A/C—alrh3ndlingunits <br /> Bathtub Forced air systems <br /> � Lavafory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 dlsposal Gas fireplace <br /> Dishwasher ^ Gas range <br /> Clothes washer Clothes dryer <br /> T Waterheator ' Rangehood <br /> '� Sink(servicalbar/mop/elc.) Exhaustfan <br /> BackOow preve�ter Heat pump <br /> � Urinal = Unitheater <br /> Drinking Fauntain Boiler <br /> Floor drain Refrigerallon <br /> Grease Vap Woodstove <br /> � Roof drains Other <br /> ' Other I <br /> i <br /> CITY OF EVERETT I,OCAI.SALES TNf CODE IS 3105 <br /> �hereby cerilify that 1 have read and examined this application and know the samo to bQ true and cortect. All provlEions of laws and <br /> ordinaces goveming this type of work will be compNed with whelher spec�ed herein or nol.The grenfing ot a pertnit does not presume <br /> to give autho' to violate ar cancel the provision of any uther state or local law requlatlng construction or the performance oi <br /> consUuctia at I am a o ' ed by fhe owner ol this property to perform the work for which applicalfon is made and I comply with the <br /> State Con ors law i CW and 296.200 WAC, <br /> �,�.=� 1 �, o � �� <br /> Signat e o er ont croriavthorizetl Agent ate <br />