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FCRMIT APPLICATIUN <br /> CITY OF EVERETT PERIl71T SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��� �O j ` ()�j� <br /> SITE ADDRESS � PARCEL TAX I.D,it PERMIT f� <br /> , , �' �x Q�i. C r -�/ C�OS73Lo �o ���7�� � 6�7C� "��- <br /> DESC. LO�N(. BLOCK TRACT � � O > 3 _ �/ <br /> R O �� <br /> OWNER ADDRESS CITY2IP PHONE <br /> - � ��,.. ���-, � Fo C�x 13677 M;�Lc�... � w���[3�-(do9-C��3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �wT . /-� . �5�-4y`� . <br /> CONTRACTOR ' . ADD FSS � � • CI7Y21P YHONE • ' <br /> �D..-,,w:� ��a.�, a�� t�. �.�, t�+3b77 �;,���.� �Z <br /> CONTR.LICENSE# , . � � p <br /> C.p��J i�[:�-� � ��l�''J . ..' . . . . . 'S��o"R-4�j— 3 <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> \� �`` _Electric �Gas_Other `3 g�� � <br /> WORK DESCRIPTION <br /> Z I�Z� 4 �� <br /> ti = 1 .�Si . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> J Toilet NC—air handling units <br /> � [3athWb � Forced air systems <br /> Lavalory(wash basin) _,� Gas piping <br /> _L Shower _j_ Walenc�alor <br /> � Kitchen sink&disposal � Gas fireplace <br /> Disliwasher � Gas range <br /> � Clolhes washer ,J_ Clolhes dryor <br /> _,j_ Wator healer 1 Range hood <br /> �_ Sink(serviceNar/mop/elc.) � Exhaust tan �i <br /> Back(low prevenler , Heat pump <br /> Urinal Unil heater <br /> Drinkinp Pountain 6oiler <br /> Floor drain Refrigeration <br /> Grcase lrap Woodstovo <br /> � Roof drains _ Other <br /> Other <br /> CITY OF EVEREiT LOCAL SALES TAX CO�E IS 9105 <br /> I hereby ceritify lhat i have road and examined this application and know the samo to bo true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will bo complied with whether specifiod herein or noL The granting of a permit does nol presume <br /> to givo authonty to violale or c r( the provision of any other state or local law regulating consWction or the pedormance of <br /> construction.Thal I am au �ed by tho own�r of this property to peAorm the worl:for which application is mado and I comply wilh the <br /> State Contractors Law �.2�7 RCW and 29G.20D WAC. <br /> ��- ��,��-� ;�/ <br /> Signature or OwnerlConlractorlAuthorized Agent Dale ��U� � <br /> � , �� <br />