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P�RMIT APPLICATI(�N <br /> CITY OF EVEn'�ETT PEI�MIT SERVICES <br /> 3200 CEDAR S'�REET, EVcRETT, WA 98201 � _ a3_C 5 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS /\RE ACCEPTED FROM 8 AM TO 4 PM �\/-)�'_/{� <br /> SITE ADDRESS I3L�I �--� PARCEL TAX I.D.# PERMIT# <br /> o �,!�D�' // <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNERt��. i1�Ay��„G_�, ADf�yS CITY/ZIP � PH I�� �2' <br /> 1 rsvV -•_'0^�G=iSGI 1 + � y� p �,Iv� <br /> �7�� � ����.�Z. �_.��� 1��i� L�4i2 IMIG�P`� 1 <br /> TE�NAANT.NAME �-y��� CONTACT FOR PERh�1T PHONE <br /> �T'W�� �5 [W�'��'�"(��' - / /'4 � �L�I ���� <br /> CONTRACTOR—^�-. � �'�y^�4DDRESS� Q � CINlZIP PHONE Cz� <br /> CONTR.LICENSE����~ � �'w � �1�� ����'�'� ��� <br /> �"141�5��5�.�.q �}'c�a4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,C�h1 ��� "�'L _E�r.clric _Gas_Olher � �5 � <br /> L <br /> WORK DESCRIPTION �e1�' � pn �� <br /> � F�,v,�1a-Fr�, ; v�e��re� 6e �r�J. <br /> q s� �e �a�,��'� ��+�,e tSI a�-�� <br /> PLU BING MECHANICAL <br /> NO. TYP[OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> _ Dathlub Forced air systems <br /> Lavatory(wash basin) � ,, Gas piping <br /> Shower ��� ���� �� � Walerheater <br /> Kilcl�en sink&disposal , '1 , ! - _ Gas fireplace <br /> Dishwasher Gas ranc�e <br /> Clolhes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/moplelc.) [xhausl fan <br /> DackOow preventer Healpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor diain Re(rigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVCRETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify Ihal I have read and examined this application and know the same to be true and wrrect. All provisions o(laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or not.The granling of z permit does not presume <br /> lo c�ive authority to violale or cancel the provision of any olher slale or local law regulating construction or the performance of <br /> conslruction.That I am aulhorized by lhe owner of Ihis property lo pe�iorm lhe work for which application is made and I comply wilh the <br /> Stalo Co raclors Law 18.27 RC and 29G.200 WAC. <br /> , � $1�_ <br /> Signat re i NCon raclod uthorize Agenl Date <br /> L -- ----- — - <br />