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P�RMIT APPLICATIO�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857- www.evereltwa.org � ..'3 .� S <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT i4 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE pADDRESS n �/- 9 PARCEL TAX I.D.# P RMIT# <br /> �/O Z3 V2S cr !/r, uni l 1 )S' <br /> LEGA LOTNO. OCK TRACT <br /> UES�. <br /> OWNER / ADDRESS CIIYIZIP PHONE <br /> �s�o� �ed�Y � �- �°X ��/S /��/%va� Y2s-7�7 oboo <br /> TENANTNAME CO�A��RPER1�1���� ��S P/ / 7—O�OD <br /> H � <br /> „ n <br /> CONTRACTOR 1. o ,( ADURESS � CIN21P PHONE <br /> CONTR.LICENSE# /\ � �D. (-��/\ �9/� /JG,K vy� <br /> US�OF BUIL ING HEAT SOURCE ONTRACT PRICE OF WORK <br /> / / <br /> �e S/�� �� � ����n�Nlkn _Eleclric �G.^s_OlY�er �Qx7 ( f/�o J ,�� <br /> onc- N 9� <br /> WORK DESCRIPTION e �{� ' o <br /> f� .I/Zt o 4 �oa eqr�n� �arfr� � h <br /> !✓�t�� �v � i in f��� � J J`�ray� roo�,� qn� /'es�r�aif l�e� /' <br /> �e M S � e9 n .L = c.. /JC .. 2 = S ?"�c� l�C1�'t 3 = � '7`tc <br /> PLUMBING � MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas pipinc� <br /> Shower Water healer <br /> _ Kilchen sink&disposal _ Gas freplace Q �t�/ <br /> _ Dishwasher � • Gasrange <br /> _ Clolhes washer Q ' � Clothes dryer � <br /> � Laundry hay �� _ Range hood �� <br />- Sink(service/badmop/elc.) Exhausl(an <br /> _ Back(low preventer /, Heat pump <br /> Urinal Unit heatcr <br /> Drinking Founlain Z�` Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> i Olher <br /> CIN OF EVERETT LOCAL SALES TNC CODE IS J705 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> I ordinaces governinc�ihis type of work will be complied with whether specified herein or noL The granling of a permit does not presume <br /> Ito give authority lo violate or cancel Ihe provision of any olher state or local law mgulating construction or the pedormance of <br /> construction.T I aulhorized by the o�vner of this property to perform the work(or which application is made and I comply with lhe <br /> Slate C a rs W 18.27 R�a�id .200 WAC. <br /> � s-a�— � �d.� <br /> SignaWre ol OwnedConUactorlAutho.� d Agent Date ��2 <br /> �' .. <br />