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PE�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS /�� �h�,�E r� PARCEL TAX I.D./ PERMIT A <br /> £Vfcl? ( � _� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITY2IP PH NE <br /> C'IIuiLCal (+� �'+1-tr� 22oi h�E1n'�l'E t?q fyEY�ri �'�1 �'i82c�{ <br /> TENANTNAME �NE�f 'r'Wf��l�[����F CONTACTFORPERMIT �( PMOME Cg� 3�0 �.$(, G ) <br /> �9�C(� �F'� I�tiaq�tlArjYMfcF ENl LE '�l�-if^q ' t-F �\ �'•2S �g� ��IL� <br /> CONTRACTOR � WS I��ke'!�'�f•�tU1�GR ADDRESS CITY2IP PHONE <br /> <CNilaleC ��urtGc5� �-}p�� �{�` qva�c Yri��t, CJletK 4'ZS`'�3� -4,G�6 <br /> CONTR.LICENSEk � (�S'jNj��rj2�0�_ 4�u ��n��Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ('clu�'�CH _ �. <br /> ✓ Electric �Gas O�ner �'�"��(�� � <br /> _ i <br /> WORKDESCRIPTION �t�pV�,�\6N <br /> ���,1 �(,�S�"'v'tj»tiS J �/ l�c�`\ /�/�''`�:� <br /> j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposa� Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryctr <br /> Water heater Range hood <br /> Sink(service/bar/mop/e�c.) Exhaust fan <br /> Backflow preventer Heat pump <br /> � Urinal _ Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Reirigoralion <br /> Grease lrap Waodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <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 goveming ihis type of work will be complied wilh whether specified herein or not.The granting of a permil does not presume <br /> to give authority ro violate or cancel the provision of any other state or local law regulating conslruction or the performance of <br /> construction.That I am authorized by the owner ot this property to per(orm the work for which application is made and I comply wilh the <br /> SlaleCantractors w 18.27 RCW and 296.200 WAC. <br /> j�� � . vntr;•,;� � 64 ���a(a <br /> Signat6r df Owne Contractor/Authonzed Agent Date l l� <br />