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ERMIT APPLICATI�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7,WA 99201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 7p 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.* P���� <br /> IyOI Gt.�X- 0�6�-t cona�colou Mo6of- �3 <br /> LEGA L07N0. BLOCK TRAC7 <br /> �5�. � 13 <br /> OWNER AODRE3S CTf21P PMONE u2s•, <br /> �F. c���w,�r �,P. i9yo� 4��'—"�w. 5� � ��,°�3c. w�o-9ati a. <br /> TENANT NAME CONTACT FOR PERMR PMONE <br /> �F. l.� � I k►J Co t vA '-1��-� 37�i3 -W c� <br /> CONTRACTOR �'[��`�Ci� ADORESS :5��p �'j CITY2IP PNONE <br /> -rHt�si�.� sTe�s�- Zc�-�7Zr�$3to8 <br /> CONTR.LICENSE N ���,��� n�V1.1�t �'�M��wA- <br /> ��l.�Nl`1 q���a �'1�7� <br /> USE OF BUILDING HEAT SOURCH CONTRACT PRICE OF WORK <br /> �]L������ V Elechic _Gas_Other g ��q , L'L <br /> WORK DESCRIPTION <br /> V�IvTi►JC� N�.W �+a�"7.�c.�-1o�J `Y�I,�x-T��q�vtlt,�.( <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flX7URE OR ITEM NO. 7YPE OF FU(TURE OR ITEM <br /> Toilet AIC—air handling untts <br /> Bathtub Forced afr systems <br /> � lavatory(wash basin) Gas pipin0 <br /> r Shovrer ` Water healer <br /> Kitehen sink 8 disposal Gas flreplace <br /> ` Dishwashor ^ Gas range <br /> Clothes washar I IL Clothes dryer <br /> Waterheater � Rangehcod • <br /> Sink(servicelbadmopletc.) � E�aust fan <br /> _ Backtiow preventer Heat pump <br /> Udnal fa UNt heater <br /> ^ Drinking Fountain Boller <br /> Floordrain j� Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains Ottier <br /> O�her — <br /> CITV OF EVERETT IOCAI SALES TAX CODE IS 3105 I <br /> 1 hereby cerltify that I have read and examined this applicaUon and know the same to bo:n,e and cortect. Ail provis�ons of lawa and <br /> erdinaces go�eml�g this typo of work will be complietl with whelher specHled hereln or not.The granUng oi a portnk does not presuma � <br /> to glve authorl to violale or cancel fhe provision of any other state or bcal law rogulaUng censtrucdon or the pertormence of <br /> constructan at I am au ' ed by the owner of this property to poAortn the work for which applicatbn is made and I comply with the <br /> Shate Con rs Law 1 CW and 296200 WAC. �� <br /> .�-=-._____ I (p a (P � , 6� <br /> Signa e o er nl ctONAuMorl22d Agent �tg �O <br /> M° <br />