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P'�RMIT APPLICATI(�nl <br /> CITY OF EVERETT PERMFT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-88�7-www.everettwa.org <br /> - - -- -� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -�EBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ��o•3� PARCEL TAX I.D.# PERMIT#n , / <br /> � A� S.� S �CX�oSOQ � �b - ��� <br /> LEGA LOTNO, BLOCK TRACT <br /> DESC. �_ I�O�• - 3Z-�O V <br /> OWNER ADDRE55 `�,,Z$ ` CITY�Ipi` eJeH�N� <br /> �x�� <br /> �J-��4�/ �x�'�S�wc._'C �20� LL C- (�r.u,,,� Ecx.2�ctl wG. �5(1Gb <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> � . ., j.ar� r:e\ `-125-315=ZBV`1 . <br /> _ '-� �Q5-�5 \ 8�0�6 <br /> CONTRACTOR K�.�"�� "� ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �Z1'L�j ���L� '61f,�°4.�. . �cu� �cYC�e1-� <br /> w�. 9�'�Sr ' .(z5-3�5-z��! <br /> USE OF BUILDING I — i1EAT SOURCE I CONTRACT PRICE OF WORK <br /> � F Q , Eleclric �'Gas O�her , c o�' <br /> (0��� <br /> WORK DESCRIPTION <br /> 31.�� � � S 'FCL- (�'��rG�cl^P^�4 � `~1 C�Aj� 2 C AZ <br /> ��a�AS� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXiURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> � Bathtub � Forced air systems <br /> �_ Lavatory(wash basin) �_ Gas piping <br /> � Shower I Watcr heater <br /> _L I<ilchen sink 8 disposal 1 Gas firepiace <br /> � Disliwasher � Gas range <br /> �_ Clolhes washer � Clolhes dryer <br /> _ Laundry tray 1 Range hood <br /> Sink(service/badmop/etc.) � Exhaust fan <br /> _ BackOow preventer Heat pump <br /> Urinai Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Greasc lrap Wwdstove <br /> Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LUCAL SALES SAX COD[IS 3105 <br /> I hereby ceritity thal I have read and examined this app�ication and know the same to be true and correct All pmvisions of laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specified herein or not.The granting o(a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or 1oc21 law regulating construction or the pertormance ot <br /> construction.That I am authorized by ihe owner o(this property to perform the work for which application is made and I comply wilh the <br /> State Conlractors L w 18.27 RCW and 296.7_00 WAC. <br /> /�t�° 6 -aa-zcx�s <br /> Si�natu ol OwnedConlr ror/Authorized Agent Da!e <br />