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F��RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—Fl�C 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM /`��� 3� <br /> �[i <br /> SITE ADDRESS PARCEL TAl(I.D.It ERMIT A� <br /> , -1 �. c r � � ac. 'b � E�.';'$7n1 �O�I 3�l 'JO D (,b U O —OU <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. �j - � 3 �U ', 3 PInT pF F,�o�\C 8 -oo ��' -� <br /> OWNER ADDRESS ���JiA PHONE/�Z`\ <br /> L J <br /> ���c-t� � I�nn \', 1-��� 2Z3.S .Mas�\�,r> a��. �`• 9touo 359 -?�43 <br /> 7ENANT NAME CONTACT FOR PERMIT PHONE <br /> L�t).5) <br /> yPJe Don\��\ � I�. R�r� D�l �CC�� E��t g82o� ZS9-138v <br /> CONTRACTOR ADDR�S,Z'/ � CITY2IP PHONE / y\ <br /> ��AtT�A n� Tf1� n� I �� 3 � <br /> ierneS �,.�� �yz- (.9Uo <br /> CONTR.LICENSE It � � ���1- �„ 9 t�� �1 �DOO T��S L1811e Z <br /> USE OF BU�LDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Lonc.�cTC <br /> C� ��. „ � � I _Electric _Gas_Other �'111�.� 6G,o�1�;�� <br /> WORK DESCRIPTION <br /> pov(� C'vv� „�,, /' !r, P� <br /> -j l-� f_�1 �-��FI��TI�nI� .l:.n f �_J11\ K�J : \O �C...} g1'• (.+�ej< <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> BathWb Forcod air systems <br /> Lavatory(wash basin) _, Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireptace <br /> Dishwasher Gas rango <br /> Ctolhos washer Clolhes dryer <br /> Waler heator Rangc hood <br /> Sink(service/bar/mop/etc.) _ Exhausl tan <br /> Back9ow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountaln Bollor <br /> Floor drain Re(rigeration <br /> Greaso trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this tyye of work will be complied with whother specitied herein or not.The granting of a permil does not presume <br /> to give authorily lo violate or wncel lhe provision of any other state or local law regulating constructlon or the perfortnanw af <br /> conslructioi�.Thal I am authorized by tho owner of this property to periorm the work for which applicalion is made and 1 comply with the <br /> Slatq Contractors la 18 and 2 200 WAC. <br /> � " � �� � > <br /> �', �,- -�+ �. ��, .� � ,-� � - l l-fl� <br /> Signature of OwnedContractorlAuthorizeb Agent Date �/ <br /> Z <br />