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r <br /> ' i <br /> ERMIT APPLICATION <br /> CITY OF EVERFTT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX n25-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 pM <br /> SITE ADDRESS PARCEL TAX I.D.� pERM1T�! <br /> 1401 �CI�IL- OOE3�t toloo Pa�i -a.l <br /> LEGA LOT NO.� ( 1 BLOCN TRACT — <br /> DESC. � <br /> OWNER "�')DRESS CRYIZIP PHONE NZS� ' <br /> � F.F. ��r�,�- L,� t9Woi 41��� w. S� � t��,►�,°�O3v �9aW a <br /> TENANTNAME CONTACTFORPERMR PHONE <br /> CF. U�1J�oPM�i�lr' I..,, P I �+N�l CoI�VA{) �-1'2S 37fd -C�-iC1D <br /> CONTRACTOR� 1f ,_�-x ',,I ADDRE3S CITY2IP PHONE <br /> �W/1'�,w r�v w�_ y�lv3 Wo00-$I�ort QO u� <br /> CONTR.LICENSE M�"�'-,w P� I�b� �Jtx�orNvcu.e °leo7'L. �-t2�: �S��`�t SSS� <br /> \JP/Q.KK•F <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �,�jt�-i��1 ...� �Eleetric _Gas_Other <br /> ...:.., <br /> WORK DESCWPTION <br /> T W H�.x1Jlo. ��.1A� LA1Jsi17.t)G`lOhl (I�Y�,�.1�-TI��1'V61t.t.' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF flXTURE OR REM NO. 7YPE OF FIXTURE OR I2EM <br /> � Toilet _ A/C–air handling units � <br /> Bathtub Forced air systems <br /> �� �avatory(wash bas(n) Ges pipina <br /> Shower Water h=ater <br /> � IGtchen sink�disposai _ Gas flreplace <br /> Dfshwasher ' Gas range <br /> � Clothes washer Clothes dryer <br /> 2J Water heater Range hood <br /> _ Sink(servicelbadmopletc.) E#�austfan <br /> _,_ BackNow preventer � Heat pump <br /> _ Urinal ' Unit heater <br /> Drinking Fountain Boiler <br /> :'loor drain Refrlgeration <br /> Grease traP Woodstove <br /> _ Roof dralns � Other <br /> Olher — <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 � <br /> I hereby ceritify that I have read and examined this appliealion and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces govaming this type of work will be compiied wkA whether spacified herein or not The granting of a pennit does not presume <br /> to give authori to violate or eancel the provision of any olher stale or local Iaw regulatlng construetion or the perfortnance of <br /> eonsUuctlo at I am a o ed by the owmer of this property to peAortn the wotk for which applicafion is made and I eomply with the <br /> SWte Con ors Law 1 RCW and 296200 WAC. <br /> �-�-----� � 10 0 �o `�Q� I � <br /> Signat e o er on ctorlAuthorized Agent ate �� <br /> . � <br />