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P�RMIT APPLICATII,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E`�ERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APNLICATIONS ARE ACCEPTED FRCfM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS FA CEL TAX I.D.# PERMIT# , <br /> � <br /> 1i.2C Nil�: 9b Z� i �o � I- y3 z. 'O i 4 - a.° ( � s''i '�� <br /> LEGA LOTNO. BLOCK TRACT CUSG9 - D�'ID <br /> oEs�. � . yu �y � L . �l 3 a .vnn <br /> OWNER ADDRESS CITY2IP PHONE <br /> �`�,�7..D�s�� .r .,� -��� �'l�'�� �rA a .P7�' r�'%�:rS' �c5�.z S'��'/ <br /> TENANTNAME CONTACTFORPERMIT �f� PHONE <br /> -� � QYk�U iTvp�`I Y1� 737 � 15� <br /> CONTRACTOR AOD'nES� CITY2IP PHONE <br /> CONTR.LICENSE U ' /..1 , � A ' <br /> ✓IN til✓� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> J ' !:� � <br /> ����7 �Electric �Gas_Olher � <br /> C <br /> WORKDESCRIPTION l�i ..'r;n ijq;i�, � �vi /IAit i�<<.,�<�' �;ntH �ro c-�.n� <br /> � � pOQ i��'1M1�q /)dtti5 �� <br /> CPq�I��1.�.i Cr�.<n:n) - <br /> ti�_I� : .�c•b �.iT: 11. rL OI il��We: rvJ:.� )� 3£ ib l)��N".�v�. 5' ( � <br /> � /{ 1 �\) (rl: FiC4i'iq:ial �. � <br /> � \V. l�Lt `Irvil < i��lrv4 �e �llbl: w"�/ :ry�!�Ci1 1�1AtitiC fiYll/ ^ P�� f,AT�}ii.:e• rC MA� :tti fiJ4.��� <br /> C-A�V�'J/�CY r;:c'.��. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet � � AIC-airhandlingunils <br /> � Bathtub - 1 Forced air syslems <br /> Lavatory(wash basin) y Gas piping <br /> �, Shower � T_ Waterheater <br /> � Kitchen sink 8 disposal � Gas Tireplace <br /> � Dishwasher 1 Gas range <br /> Cbthes washer Ciolhes dryer <br /> _ Laundry tray y Range hood <br /> Sink(service/badmop/etc.) _ Exhausl fan ?'1,� <br /> Backflow preventer _ Heai pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of H•ork will be complied with whether specified herein or noL The granling of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br /> consWction.That I 2m authorized by the owner o(this property to peAorm the work for which application is made and I comp�y with the <br /> State Contraclo s Law 18.27 RCW and 2�6200 WAC. <br /> �f-�/:r-�'��"�-- -�,=n 5 � t <br /> Signature of OwnedContra odAuthonzed Agent Date � <br />