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� PE�14�lT �►PPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 i,EDP.R STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.2verettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDFtESS PARCEL TAX I.D.# PE�MIT# � <br /> A� z �� ' �� �L�C.%� oZC�� ��� _�> � �� I', .� I <br /> LEGAL LOTMO. BLOCK TRACT <br /> DESC. SE� <br /> � <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> Y�LE-��-1��" c..(�E-t� (od� �r11VE7L511�-1 S7'� SC�T� <br /> k��-�nr1yS ��.� s�n-c- zszo 9�i�i �2����''�� S31cN <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> Z`1W11�Z I 4tY1(�ti'� c-��s��t•l ��Lo�•..� '�'iS--z$`5'j <br /> CONTRACTOR ADDRESS CITYILP PHONE <br /> 5 UA '-cC�IL.�-1�r�' 15�t N 2o�th �' sf4�zEv+� <br /> CONTR.LICENSE p <br /> � Sca/aGo�� oay&s (�f�-� Sz'S-Zt� 1 _ <br /> USE UF BUIIDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��F�c...� WAT�-�S� — <br /> � � S_� _Electnc�Gas_Other `.��5 �»'�j <br /> WORK DeSCRIPTION <br /> C.�tJr"�'-tT1c.� f��,,.� �.Ir�Ga (z�e.�n.� i �JATL` �i-�I�cc <br /> /�c-1 �' '`�'`'����v'`� �c� Sh1GL t"'���-Di!`�h . <br /> PLUh161NG MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � <br /> � Toilet A/C-a�r handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laimdry tray Range hood <br /> � Sink(service/bar/mop/etc.) Eahaust(an <br /> Backflow prevenler Heat pump <br /> � Unnal Unit heater <br /> ' � Dnnking Fountain _ Boiler <br /> Z Floor drain Refngeretion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify that I have read and Pxamined this application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of wod,will be complied with whether specified herein or not The granting of a permil does not presume <br /> to give aut ority to violate or cancel the provision of any other state or local law regulaling construction or the performance of <br /> construcUon. That I am authorized by the owner of this property to perform the work(or which application is made and I wmply�vith the <br /> State Co tr tor� R9�29620� �� <br /> Sg tu e of Ownerl on�rador/Authonzetl Agent ' ate �Il <br /> I <br />