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�� <br /> P F�.MIT APPLICA�I�N <br /> CITY OF EVERETT pERMlT SERVICES <br /> C�a,�����`� 3200 CEDAR STREET, EVERETT,WA 98201 <br /> ,� ,� 425-257-8810-FAX 425-267-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br /> SRE ADDRESS PARCEL TAX I.D.$ PERMITYI <br /> IyOI �Ct.�lt- OOE3�-t a�occ�c�loo Po�ai-�z� <br /> LEGA LOT NO. BLOCK TRqCT <br /> DESC. <br /> I <br /> OWNER � ^ qDUtiE$S CITY2IP PHONE ' <br /> F F. O��r��fln��n- L,P. 19401 4��+� W. Su� � t�� °�o3�e '�z5'- I <br /> , (d-to`i1yo� <br /> TEMANTNAME CONTACTFORPERMIT pNONE <br /> ��. ��uvpr� I� P I �.1 ���.vA� '-t��= 3ya -a-to� <br /> CON7RACTOP, AbDRESS CITY21p PNONE —_ <br /> ON�t•�.�A.uwg+�M In�4 x oro3 wo�.-s�.r er� �� U'c No1 <br /> CONTR.LICENSE f{��w*P���Qo �/Jp�, µtt,c� ��y l �J ` Irj{� ��� <br /> [717 <br /> USE OF BUILDING HEAT SOURCE CONTRACT pRICE OF WORK <br /> � ��f"��'� � v Electric _Gas,Other <br /> WORK DESCRIFTION <br /> �l�lY►��j11��o N�.1�.� �b1J5I'iwG.i"lohl 11�1'�.Ul-'C��iVI(u.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Tailet A�C—air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash besin) Gas piping <br /> � Shower � V1�ater heater <br /> � �tch�n sink&disposal Gas fireplace <br /> � Dishwashor Gas range <br /> Clolhes washer Clothas dryer <br /> Wa.ter neater Range Fwod <br /> Sink (se�,vlee/barlmopletc.) Exhaust fan <br /> BackNow preventer Heatpump <br /> � Urinal ` Unit heater <br /> � �rinking founlain Boiter <br /> � Floordraln � Refrlge2Gon <br /> Groase trap � Woodstove <br /> Roof drains , Olher_ <br /> 01her <br /> GITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> I hereby ceritify that I have read and examined this applice6on and know the same to be trua end correet. All provisions of laws and <br /> ordinaces goveming this type of work will be compliad wllh whether spsci�ed horeln or not.The granting of a pertnit does not presume <br /> to give autho ' to violate or cancel the provision of eny other slate or local law reguiating co�struclion or the pertormance of <br /> constructbn nt I am au ' ed by the owner of thls pmperty to psrform the work for which apptication is made and I comply with the <br /> State Con ors l2w 1 CW and 296.200 WAC. <br /> �--'�"� � �o � �P <br /> Signa B 0 B� Or, ctorlAuthori�ed Agent ate �(� <br />