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APPLICATION <br />I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257-8810 —FAX 425-257-8857 — 7^�nv.v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRESS W/�L S%rLP-ET P�I�. PARCEL TAX I.D. # ggERMIT # <br />3_lY��� <br />LEGAL NO, BLOCK TRACT OR SUBDIVISION # <br />DESC. <br />—LOT <br />CWNER ADDRESS CITYIZIP PHONE <br />r �_ PVe�II' �82D1 4��•�5-��9 <br />TEAr-N��TNAME � <br />CONTACT/PERMIT PNONE ^q�.L2S7,�gp 71' <br />l�-'-'��io��%��✓c- <br />���L�FOR <br />7/� <br />l.J%7�c.lS L-J7K-l�-- E-MAIL GTjoc`(1�.(•'GI. CVG7'IGff <br />CONTRACTOR ADDRESS CI Y/ZIP PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_Electric X Gas _Other dt ,,��� �� <br />WORK DESCRIPTION <br />7t-NA,V r /44P/rc'V0�'lvfE,crT�, 7a 7A�� li' .bTy 1=1,cM5 cy= Iu9/1. srrZZiFr <br />NC-GV GUALLs TcU25 FUMuTes _t; Ch�T <br />MECHANICAL <br />PLU BING <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C - air handling units � <br />8all7lub <br />_Forced <br />air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping <br />Shower <br />N'ater heater <br />_ <br />� <br />Kitchen sink & dispese!- <br />Gas fireplace <br />Dishwasher <br />_Gas <br />range <br />_ <br />_ <br />Clothes washer <br />Clothes dryer <br />Water healer <br />_Range <br />hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_Exhaust <br />fan <br />_ <br />Back6ow prnventer <br />_Beat <br />pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_Boiler <br />_ <br />Floor drain <br />Refrig•• ation <br />_ <br />Grease trap <br />Woodscove <br />_ <br />Root drains <br />_Other <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify 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 work will be compiled with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />construction. Thal I am authorized by t e owrer of Ibis property to perform the work for which application is made and I comply with the <br />La W 296.200 WA-'. <br />Sl22M, <br />rrrs n <br />Si a u e of O er/ ontractor Authorized Agent al <br />t(� <br />V <br />PERMIT <br />