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SITE ADDRESS <br />U <br />LEGAL LOT NO. <br />DESC <br />TENANTNAME <br />� <br />FcRMIT APPLICATIvN <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 ACCEPTED FROM 8 AM TO 4 PM <br />OLOCK <br />PARCEL TAX I.D. p <br />TRACT OR SUBOIVISION # <br />L ��� <br />CONTACT FOR PERMIT <br />curvinnci�n ru� <br />Te w, C•u �4� s Ce v� 5-{-u : <br />CONTR.IICENSEk � Or1L•��c_ �o t5c.s <br />USE OF BUILDING <br />O i(YN�I. <br />DESCRIPTION <br />�'l1//�� <br />NO. I TYPE OF FI%TUR[ OR ITEM <br />T odcl <br />Ba1hWb <br />Lavatory pvash basin) <br />Shov+er <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />��cktlow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />3 t��_r,� 1�, <br />HEATSOURCE <br />,� Electric _ Gas _ Other <br />NO. <br />P�I�MIT It <br />%CD� - 9 <br />21P PNONE <br />c?t{V�1� �{z5-33`T-�`L <br />PHONE <br />E-MAIL <br />7�Ra <br />a{2�Zto-59c� <br />v S'�a�i���tc�,.LC�c9 `Tg12 <br />CONTRACT PRICE OF WORK <br />� <br />. �O L.S� <br />�/�..�J� <br />MECHANICAL <br />TYPE OF FIJ(TURE OR ITEM <br />A/C - aii hand6ng units <br />Porced air systems <br />Gas pip�ng <br />Water heater <br />Gas fireplace <br />Gas range <br />Clo�hes dryer <br />Range hood <br />Exhaus� fan <br />Healpump <br />Unil hea�er <br />�oiler <br />ReMgeralion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAI SAL[S TAX CODE IS 3105 <br />I hereby ccrtify Ihat I have read and ezamined lhis application and know Ihe same to be Irue and coned. All provisions o1 laws and <br />ordinances goveming this type of work vrill be complied with whether specifed herein oi not. The granling oi a permd does not presume <br />lo give aulhority lo violate or cancel Uie provision ol any olher sta�e or local law requlating conslruction or It�e performance of <br />construction. Thal I am authorized by Ihe owner ol lhis pwperty �o perform the'.vork br which applicalion is made and I comply with Ihe <br />State Coniradors La v 1927 RCW and 296200 bVAC. <br />< < " � ti' � /`Za5 '� � <br />Signatwe of vnedConiracto:/Authori¢ed Agent Da�e <br />'/ i <br />/ l — <br />