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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAk 425-257-St357-www•everettwa.org <br /> APPLICATiONS ARE ACCE.PTED FROM 8 AM TO 4 PM � ..� I�� 6 <br /> SITE ADORESS PARCEL TAX I.D.il PERMIT# <br /> 8.2.5 '�c <�� V . : -, <br /> IEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS i�SZ C / 9(o C�TY3IPS�-J PHONE, G�/N�% Q"P�O� <br /> ��i't^� Q J/CJ iI' <7 <br /> .S'-r-�u'� W � l_l.� µl�a�S r-vi✓� i�iZo.�,a �v< <1�5-S�Dl-O l 9 S� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> C� wv�a %2'i'ic 7r��i ��K �'�r.a.`1 �f� S -�� %- ES 3 3 C) <br /> CONTRACTOR ADDRESS C TY21P PHONE <br /> co,:r,o��� ,—� ��vs ss .�v,C� �3, S:I:J.✓ySrvJ£� �3l✓c1. S� E-✓� 9f1Zo5 <br /> CONTR.IICENSE# yzs- 3�7- z�°�' <br /> C°ac�t��c c�,5 D80L� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> / <br /> .�j?£.S , _Electric _Gas VOther y 70�� � <br /> � � — J <br /> WORK DESCRIPTION � n -- � /� C CGi CJL <br /> �� rJ U t, �- / /-�E � Ti�cJ ci � ' ' ' � T C� � � <br /> C��a S� ; �/�£c?c •1 c� w ,� -r� I-1£sa rrs� t� � r�+ Gi•4s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> 6alhtub Forced air systems <br /> lavatory(wash basin) ,� Gas piping <br /> SL•ower � Walerhealer <br /> Kilchen sink 8 disposal �_ Gas fireplace <br /> Dishr�asher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer _ Range hood <br /> Sink (servicelbar/mop/elc.) _ Exhausl fan <br /> Backflo�v prevenler _ Heat pump <br /> Urinal Unil heater <br /> Gcinking Founlain _ Boiler <br /> Flcor drain Re(rigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Olher _ <br /> Other <br /> CITY OF EVERETT IOCAL SALES TA%CODE IS 3705 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be true and correcl All provisions of laws and <br /> ordinaces yoverning Ihis�ype of work will be complied�vith whether specified he�ein or not.The granling o(a permit does not presume <br /> lo give authority to v��lale or cancel lhe provision of any olher slale or Iocal law regulating conslruction or the perfomiance of <br /> conslruclion.Thal I am authorized by the owner o(this property lo perform the work for which applicalion is made and I comply with the <br /> State .qrs La� 7 RCW and 29G200 WAC. <br /> ��__���.�� <br /> $iyna o wner tre r/Aulhonzed Agent Date <br />