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PERMIT APPLICATIVN <br /> �I'TY OF EVERETI' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.oro <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Q� IS�O(7 <br /> SITE ADDRESS � PARCEL TAX I.D.# jE&MIT# <br /> ��o E V�eu� (��d e D�: �o�oC 4 0�� aC�C�a c IC�G�2".Y�� _ <br /> L[G�L lOTNO. BLOCK TRACT <br /> DESC. � ' 7. " — <br /> OWNER AODRE55 CITY2IP PHONE /�Z� <br /> l�l��d1o�21 d .JC(�1�1" �I G�U' ' �C1�1C - EI�1���f I.�)A �5Z �x1 b 7 <br /> TENANT NAME CONTA(;T FOR PERMIT PHONE <br /> ,� � c� I 3rc!� I l � c�� �� 2c�(n 71888Z3 <br /> CONTRACTOR � I� AUDRESS CIN!ZIP PHONE <br /> CONTRLICENSE# �l.lVl`JT GT�����I�1���' F/�JC [f2.0 - �S�' ZC7 � J <br /> USE OF BUILDING HEAT SOURCE I CONTR,aCT PRICE OF WURK <br /> ��(.`� I Ci C 1�1�1 Q � _Eleclric �- Gas_Other �"�;,,��� " <br /> WORK DESCRIPTION ����� ����� i�'J��!/C ���� � <br /> ��l�I�IC.�CI e� '� <br /> iy�,t.o..<� , ,,,� ��, C C�( ��1 ct,4..L� i1.DZ��'K� , �,�Du�C��( ,�C�L��., ��i�j��I <br /> C� �(�.c <�� �- �' � z��---�—n__-__ � r=�� <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIxiURE OR ITEM N0. TYPE OF FIX':IRE OR ITEM <br /> Toilet PJC—air handling uni�s <br /> 3� Bathtub Forced air syst�ms <br /> Lavalory(wash basin) � Gas piping <br /> I Shower •1 Waferneater <br /> Kilchen sink&disposal _ Gas(ireplace <br /> �ishwasher Gasran�e <br /> �_ Clolhes washer _L Clothes dryer <br /> Waler healer ,��y— Ranc�e hood <br /> Sink(service/bar/mop/etc.) �� Exhaustfan <br /> ,� _ Backflow prevenler _ Heal pump <br /> Urinal Unit heatcr <br /> Drinking Foontain = Boilcr <br /> Floor drain _ Relrigeration <br /> I Grease irap _ Woodslove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and ezamined this app;icalion and know the same lo be true and correcL All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specilied herein or not.The granting of a permit does not,resume <br /> to gi�e authonty tu violate or cancel the provision of any olher state or local law regulating constn,clion er the perfonnance of � <br /> construction.Thal I am authorized by lhe owner ot lhis property to pertorm the work for which application is made and I comply with the <br /> Slale Coniractors Law 18.27 RCW and 296200 WAC. <br /> Signature ot OwnedCo�lractor/Authorized Agenl Dale I <br /> �Z <br /> � _— ---- - - - - ---- - <br />