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� <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www,everettwa.org <br /> APP�ICATIONS ARE ACCEPTED FROM 8 AM TC 4 PM <br /> SfTE ADDRESS PARCEL TAX I.D.# PERMIT A� <br /> 1�-IOl �C�EI� O��'-t Oooa�colo0 I���o1-0�3 <br /> LEG lOTNO.� �� BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS GITY2IP PMONE N�5`�, <br /> ��. O���wn�wr- L,P. 19y01 4��� w. S►�r� � ��,°�o3V ca�o-9a�+a. <br /> TENANT NAME CO{ITACT FOR PERMI7 PHONE <br /> F.F. O�ur�r l. P � E;,+.f,,) Co��vA� �tzS 3z�s -c�-tn� <br /> CONTRACTOR • ���,JL �� ADDR�:SS CITYIZIP PMONE <br /> �''1. 2viu3 'w000• s�a-t. Ra N� �7�- t,t8 �-�-t5�"S` <br /> CONTR.LICENSERO���P� �a�� UlO�J��IU�I.(,f� 9S0'1�L <br /> 1 <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� ��„� Y Elachic Gas Other <br /> WORK DESCRIPTION i <br /> Pw��►�1� N��,.� ��u-��.► l►rn.�,-��,�,�w � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NQ. TYPE OF FIXTURE OR ITEM <br /> 7oilet A/C—air hendling units <br /> 6athtub � Forcedairsystems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Weter heater <br /> � Krtchen sink d disposal _ Gas flreplace <br /> � Dishwasher Gas ranpe <br /> �t Clolhes washer Clothes dryer <br /> Walerheator Rangehood <br /> Sink(servicelbarlmopletc.) _ Exhaustfan <br /> � Backflow prevent¢r Heat pump <br /> � Urinal _ Unit hcater <br /> � Drinking Fountain Boiler <br /> ploor drain Refrige2fion <br /> � Greasetrap Woodstove <br /> Roof drains Other <br /> Other — I <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritlfy that I have read and exam?ned this application and know the same to be true and cortect. All p�ovisions ot laws and <br /> ordinaces goveming this typo of work will be complietl with whelher specified herein or nol.The grantlnp of a pertnit does not presume � <br /> to give autlio�to violate or caneel the provlsion of any other slato or local law regulating construction or ihe perfurtnance of <br /> construction at I am au o 'zed by the owner of this propeRy to perform lho work for which application Is made and I comply with the <br /> State Con . nrs Lew 1 RCW aod 296.200 WAC. <br /> ,�.__... 1 !�, a (o �.0� <br /> Signat e o er on ctor/Authorized Agent ate �� <br /> �O <br />