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SITE ADDRESS <br />LEGAL� LOT NO. <br />DESC.� � — � <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMI7 SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everatiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO M NM <br />IPARCEL TAX �.D. # PERMI7 N <br />_�o�f 3�97 89oogc�a Sosc�&-cr3� <br />BLOCK (RACT <br />�E''i7 Jvr��iCl � ���C��/ Z�Tk- l,�'.�1J� 2f��Cf �i�O�J(!?'_ ��� �T <br />V <br />TENANTNAME � I CONTACTFORPERMIT PHONE � <br />�' <br />I o �..� S� rr� �� � yZs �_ p t y_ <br />CONTRACTOR �' ��1, t �� ;� ADDRESS " CITYILIP PHONE <br />r �: ��,�..1- �� . 3c l� ��� ►�y a„� �-g3�� �+ ��^ ;. <br />CONTR. LICENSE M c_ �% 7 y�� � <br />�,02 -2G�, 1�3 , -I�-U% c�•��e3� �.�a 48zc� ��yt <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />� Electric Gas Olher "� sOp�' <br />WORK DESCRIPTION , L �% �r <br />�P4i1� ��L/� 1OQ..�'� �I001`� � ��OQ T��S.',- <br />� J <br />NO. I TYPE OF FIXTURE OR Il EM <br />Toilef <br />Bath�ub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & dis{wsal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NU. � TYPE OP FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Ezhaustfan <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigerelion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />1 hereby ceriti(y Ihal I have read and examined this applicalion and know Ihe same to be true and cortect. A�I provisions of la•Ns and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting oi a permit does not oresume <br />to give aulhonty to violale or cancel Ihe provision of any olher stalo or I�cal law regulating construction or the pedortnance of <br />construction. That I am authorized by the owner o( this property to pedorm the H•erk for which application is made and I cornply with the <br />Stale Contractors Law 1827 RCW artd 29G.200 WAC. . <br />� 7�� � ��, y� <br />SignaWre of Owner/ n rector7Authorized Agent <br />