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P�RMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVF_RETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8tt57-www.everettwa.org � - �3-� S <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(,05 Db�03� <br /> SITE ADDRESS��j�' -�F�, PARCEL TAX I.D.# PERMIT# <br /> ��;-�- <br /> p � sv�-orU <br /> IEGAL LOTNO BLOCK TRACT <br /> DESC. <br /> OWNER ��f�r�� AD19yS _ CITY2IP �� �I Z�` �� <br /> il0 st$�l <br /> �a'�I�i ���'`LT�iz. �Y�R'�1T` L.k1 ���1���� 1� <br /> TENANT NAME CONTACT FOR PERM1—I�T PHONE <br /> �A{Yl� pS ��tEE2. l'�r_-,f-�,_,�� <br /> a�� S- <br /> CONTRACTOR ` ^ �(y.^�DDRESS�Q � CITY�ZIP PHONE ��`2 <br /> CONTR.LICENSE# f ''���o5�p ` , �� �r��i�'�'� �y 7 <br /> NY 1 �t'C�SfJ�"1 <br /> c <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��f� ��� '�'+ �� _Electric _Gas_Olher � Zf� e�„iC..C� <br /> l <br /> WORK DESCRIPTION ������ pn �- ,� <br /> a' F�v,,�larka� � v�e���re� be c�c��l. <br /> j� s� (� �d��C ge��=1�,�,e f� a��g�. <br /> PLU BING MECHANICAL <br /> NO. TYPE O�FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel WC—air handling units <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink &di-posal Gas fireplace <br /> Dishwasher Gasran�e <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mop/elc.) [xhausl tan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heatcr <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERFTT LOCAL SALES TAX COD[IS 7t05 <br /> I hereby cerility Ihat I have read and examined this application and know the same to be lrue and correct. All provisions o(laws and <br /> ordinaces goveming Ihis type of work will be complied with wheUier specified herein or nol.The granting of a permil does not presume <br /> to give aulhoriry lo violate or cancel the provision o(any olher stale or local law regulalinc�conslruclion or the performance of <br /> conslruclion. hal I am authorized by lhe avner o(this property lo pedorm lhe work for which applicalion is made and I comply with lhe <br /> Slato ConU lors Law 10.27 RCW and 296.200 WAC. <br /> �. � <br /> Signature of O ned ntractodAuthorized Agenl Date <br />