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P�RMIT APPLICATI(>nl <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CED.�R STREET, EVEF:ETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org �t•� s� � 5,�� <br /> / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CP.RDS ARE NOT ACCEPTED <br /> SI7E ADDRESS �)�,3�Z .j S�. PARCEL TAX I.D.N PERMIT# , <br /> r��s ,� 5�3 0� a� 5c�o Sv��..� <br /> LEGA LOTNO. BLQCN TRACT <br /> DESC. � <br /> t�-n.�- 3'Z-o y <br /> OWNER ADDRESS CITYI IP PHON <br /> ���E �Y�cS ^�� C�2o� L�—L l2'l2E'j ��.�'cl� Gcs—� H�-- <br /> Ew—� u.� , �i Fs20ES <br /> TENANTNAME I CONTACTFORPERMIT pHONE <br /> ..� , ' . ' +�.ti �F�g-3�,-tg�V., , . . <br /> . . � � �J�r-�v� l �e 1 � —`12 S'�5 �1-�ic��6. <br /> CONTRACTOR �`� T�,..�L_ ADDRESS CITY2IP PHONE <br /> ( Z'1Z9 13a��.� ll 4r;"�{. bJw`� �y - `� <br /> CQNTR.LICENSE p � '� • �,c �� � �l�-��37�7–��11 <br /> tax.-� C�.+� . -�c�5'2U�S' <br /> USE CF BUILDING HEAT SOURCE I CONTRAC7 PRICE OF WORK <br /> S` �� , _Eleclric ��as_Other / S��00 <br /> \d <br /> WORK DESCRIPTION <br /> l S �2- 1-1c�3 H -Z ca-� � A-�aSE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXNRc OR ITEM <br /> Toilel A/C–air handling units <br /> BathWb � Forced air systems <br /> � Lavatory(wash basinl Gas piping <br /> Shower � Waterheater <br /> � Kilchen sink 8 disposal 1 Gas fireplaco <br /> Dishwasher 1 Gasranqe <br /> I Clolhes washer � Clolhes dryer <br /> _ laundry tray I Range hood <br /> _ Sink(servicaNadmop/etc.) � Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking FouMain Boiler <br /> _ Floordrair, Refrigeration <br /> � _ Grease hap Woodslove <br /> Roof drains Other <br /> � Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and exariined this application and know the same tu be true and currect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granling of a permit does not presume <br /> to c�ive aulhonty lo violate or cancei the provision of any other state or local taw regulaling constniction or the perform3nce of <br /> conslruclion.That I am aulhorized by the owner of lhis property to peAorm lhe work for which application is made and I comply with the <br /> State Contr�aw 18.27 RCW and 296.200 WAC. <br /> /, y ���--z�s <br /> Signature er/fdonlrectoNAuthonzed Agent Date - <br /> / <br /> �� c ��� � ' �I2 � <br />