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�`tRMIT APPLICATIC�N <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 ACCF.PTED FROM 8 AM TO 4 PM �S� _ c <br /> SITE ADDRESS I�j3 3 PARCEL TAX I.D.# PERMIT# <br /> co�0 �Gts ' ��` <br /> LEGAL lOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PH E <br /> f�J1D�rtG'E.�r� 19'la � Z!o l '�0�3 <br /> �,'�I�L—�'�'n-r��- ��R�iT' bJd aj'—��T"¢ ty4c'Ic,P <br /> TENANTNAME CONTACTFOR PER T PHONE <br /> �Atkl� o.S �(,.�r`le� /.����,,� �c.�. �L� 3�d— <br /> CONTRACTOR ^ ��DDRESS`O Q � CITY2IP PHONE �z�� I <br /> CONTR. LICENSE p �- r^ L�S�OS.4L..9 • I "D' � ��p` ,w.^'(r1'���,'��1� �y �`�`� <br /> V�•� � `�i tivLl/��'I <br /> .—a <br /> USE OF 6UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �"�'�1� ���~�'�� _Eleclric _Gas_Olhor � 65��� <br /> WORK DESCRIPTION ����r � p� � <br /> g(' F�►�lv�fra� • v���erre� be wr��l. <br /> q s�h��e ��,��� ��le�� � a���, <br /> PLu(��BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTUR�OR ITEM <br /> Toilet A/C—air handling units <br /> �athivb Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher � �, Gasrange <br /> Clolhes washer ! l. ��t:r U Clothes dryer <br /> _ Laundry lray .� _ Range hood <br /> �° �:"Yk_��l(�N� <br /> _ Sink(service/bar/mop/elc.) J ,-! Ezhausl fan <br /> BackOow prevenler ` Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler � <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Otlier <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal 1 have read and examined lhis applicalion and know lhe same lo be true and correcl. All provisions of Iaws and <br /> ordinaces governing lhis lype of work will oe complied wilh wholher specilied herein or noL The granting o(a permit does not presume <br /> to give aulhoriry lo violate or cance�the provision of any other stalc or local law regulating consWction or the per(ormance of <br /> conslruclion.That I am authorized by the owner of lhis property lo pertorm lhe work for which application is made and I comply�+ith lhe <br /> Slale Cont actors Law 18.27 RCW and 29G.200 WAC. <br /> Sfu.lo� <br /> Signatu of Own /Conl actor(Au i rized Agenl Dale <br /> I <br />