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�ERMIT APPLICA � ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE'ACCEPTED FROM 8 AM TO 4 PM <br /> SIT'�qpDRESS PARCEL TAX I.D.#� <br /> `(.,�Ol PERMR# <br /> I,C�IL 00�''l OOC�COcol00 T�C�o� -- h 6 � <br /> LEG LOT NO.�� BI.00K TRACT <br /> DESC. <br /> OWNER ADDRE <br /> CIlY21P VNON y2S� <br /> � �F. ���w.mAm�r L,� t9�lo� 4��`�w. � �90 �,�,.°�a°3v �9a�a. <br /> TENANT NAME CONTACT FOR PERMIT <br /> Fr Q��LI(JPYN f�f� L P I PHONE <br /> �t+�.l ���vA� y�zS' 37-5 a-l� <br /> CONTRACTOR ApDRESS CRY21P PNONE <br /> O�W� f�wv�ia4 l�„ �1a3 <br /> CONTR.LICEN3E A ��'� � � �TiS �'Iag�—�'IS'Ss <br /> ON�.s�rt��lE Iqlo 8Pl t,J�wv�u.� 9�D Z <br /> USE OF BUII.DING HEAT SOURC CONTRACT PRICE OF WORK <br /> I�u1lX'IF�'IN� ���J4 I �Electrlc _Gas,Other I <br /> � <br /> WORK DESCRIPTION <br /> �ww�*A� N�v.� G��euu-�o�,l lm,u�,-�r-�v�iu..� <br /> PL.UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR REM <br /> Toilet A/C—air handling units <br /> '-t7 Bathtub Forcedzirsystems <br /> ?. lavatory(wash basin) Gas piping <br /> Shower Water heator <br /> �� KtcFien sink&disposal � Gas fireplace <br /> � Dishwasher Gas range <br /> � Clothes washer _ Clothes dryer <br /> Water heater Range hood <br /> _ Sink(service/badmop/etc.) E�aust fan <br /> � Beekflow preventer Heat pump <br /> _ Urinal UnR heater <br /> , Drinking Fountain Boiler <br /> Floor drain Refigeration <br /> _ Grease trap Woodstove. <br /> _ Rooidrains � pther <br /> � Oth9� <br /> CRY OF EVERETT LOC/LL SALES TAX COpE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same M be true and crorrea. All provlsbns�t laws and <br /> ordinaces goveming this typa of work wili be wmplled with whether specified herein or not The grantlng of a pertnit dces i�ot ptesume � <br /> to give authoH tp vfolate or eancel lho provision of any other slate or loeal law regulating constrvetion or Ihe performance of <br /> constnxibn at I am au ed by the owner of this property to perfortn tha work for which appilcadon is made and I comply with the <br /> State Con ors I.aw 1 CW and 296.200 WAC. <br /> ..�..�� ! � a (o I �v�— <br /> Slgna e o ar on ctor Authorized qqent ate `` ' <br /> . ;1�V <br /> ' ` lJ <br />