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�, <br /> PE�2Nl�T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> r 3200 CEDAR STREET, EVERETT, WA 98201 <br /> a <br /> � 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br /> SITE ADDRESS PARCEL TAX I.D.# ' PE4 IT# �� <br /> �'�7 �C ' � U . , _ �G'�i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> 9�37 5 <br /> Kv�� fIEC,`E",vOC�,�Y� �.?`- y9�.�L� 1� muK��FE� y25-z3Z-3O�y <br /> TENANT NAME � CCI.NTACT FOR PERMIT PHONE <br /> U/�'-kJ� � ��Y� M4-�Cc.�rT �Z5 �75--�o�/��y <br /> CONTRACTOR ADDRESS CI7Y21P PHONE <br /> DAY � n,�iTE .'�>>.s�� d-Hrl• /l�Gl�l %�.�iP.Ac�Gv f yniNu�irJD �125'?�✓'(r�li'� <br /> CONTR.LICENSE#D��N.z:nH��y�rC'n1 ��37 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other � �`�'J,Gv <br /> / <br /> WORKDESCRIPTION ��Q`��� ��J�M1�� ^� ��LL FGl�'-NAC:� G��� <br /> (7" <br /> i <br /> N�-'cJ C9�is GC!�K.L Fu��A-e�� .1 N SPr�� LGC.4t1v1� - <br /> PLI�MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> 6alhtub _ Forced air syslems <br /> Lavstory(wash basin) _ Gas piping <br /> �hower _ Water heater <br /> —I Kilchen sink&disposal _ Gas(ireplace <br /> ' ��shwashcr Gas rangc <br /> Clothes washer C�olhes dryer <br /> Waler heater Rsnge hood <br /> Sink(service/badmop/elc.) _ Exhaust(an <br /> Backflow prevenler Heatpump <br /> Urinal = Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CIN OF EVERET7 LOCAL SALES TAX CODE IS 9705 <br /> � hereby cerilify thal I have read and examined this applicalion and kno�v lhe same lo be L-ue and correcL All provisions of laws and <br /> ordinaces yoverning Ihis type of work will be complied wilh whelher specified herein or not.The granting of a permit does nol presume <br /> I lo give authnrity to violale or cancel lhe provision ol any other slate or local law rcgulating construc!ion or the pedormance of <br /> co�struction.That I am authori�ed by the owner of this properly to pedorm lhe work for whi�h application is made and I comply wilh lhe <br /> I Stale Cnn�ractors Law 18.27�CVJ riti G''L00 WAC. <br /> �=,� ��_ ��z-���� �/��v7 <br /> SigiTatUre o wnedContractor/A hoiize�gen�� Da�e <br /> I <br /> � <br /> � ---- �- ----- -- -- - - — — <br />