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P�RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 G) -13 -�� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P� (X�' - ' <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �a o �G< <t 00 39�10 -000 - Q �- dC� <br /> LEGAL LOTNO.� BLOCK TF�AC �1 C <br /> DESC. p 6 �J <br /> OWNER ADD�ESS CITY2IP PHONE s'.Z)S',tSS <br /> iSO�( da 1 <br /> /��G�^.C�c � f���tv� ��LS�<uG��dv� 1K336 A�nrvtti �vca/. II� �ceG'Nc 9813 � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Ic� ��I��u�v� y.�s ���s-a.�sr <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �^ �C� /� ^ �� �lO � / <br /> � _� r�r.`. d <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eleclric Gas_Olher <br /> WORK DESCRIPTION � <br /> �1����t.S � � `�(� /� Gl.t,c�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> y Teilel A/C—air handling units <br /> �Y Balhlub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater hoaler <br /> � Kilchen sink 8 disposai _ Gas fireplace <br /> � Dishwasher _ Gas range <br /> � Clolhes washer _ Clothes dryer <br /> � Water heater _ Range hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healsr <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and kno�v the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specified herein or nol Tho granling of a permit does nol presume <br /> to give authonly tu violate or cancel the provision o(any other stale or local Iaw regulating constructinn or the pedormance of <br /> consiruction.That I am authorize by the owner o(this pro arty to pedorm the work for which application is made and I comply with lhe <br /> Slate C iractors Law 7 and 296.200 WA <br /> L - � - Q� <br /> ! ontractodAulhorized Agent Dale <br /> . / <br />