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P�tRMIT APPLICATIC�N / <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, F:VERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLIC�iIONS ARE ACCEPTED FROM 8 AM TO 4 PM /� -'�.�-!IS <br /> SITE ADDRESS PARCEL TAX I.D.# PERM�T N <br /> 322o s+Fe2� A vE o s � -+ o0 o i i o 1J � - � <br /> LEGA LOTNO. BLOCK TRACT / <br /> DESC. A <br /> LJ 5 QAL1�TlJrJ "7U `��TT <br /> OWNER ADDRESS CIN21P PHONE <br /> DA a__ �ti.� 5 sR n+C ,,,� � _ - y <br /> TENANTNAME CONTACTFORPERMI7 PHONE <br /> 7Y�.ETL Ol..1C..� /1�An1 UL�lS I <br /> CONTRACTOR ADDRESS CITYlZIP PHONE <br /> CONTR.UCENSE p <br /> USE OF BUILDING I HEAT SOURCE I CON7RACT PRICE OF WORK <br /> ������.� �Electric �'Gas Olh�r <br /> WORK DESCRIPTION <br /> L�n�O 1•{0,�1� n..rn Gti:s�r.y� - <br /> � cA'�JV� CJrrG'C.TC F{l�..l.- /-1�wA;'; <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ ioilel A/C-airhandlinc� units <br /> _ f3alhlub ForceA air systems <br /> __ lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kilchen sink&disposal Gas tir�place <br /> _ DisMvashcr Gasrange <br /> _ Clolhes washer Clothes dryer <br /> _ Waler healer Range hood <br /> Sink(service/badmop/etc.) Exhaust tan <br /> _ �achllow prevenler Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Pounlain Boiler <br /> _ Floor drain Refrigeralion <br /> Grease IreP 1Noodslove <br /> Roo(dreins Other <br /> Olher — ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceri�ify that I have read and examined this applicalion and know ihe same to be true and correct. AII provisions o(laws and <br /> ordinaces gov rning Ihis rype ol work will be complied wilh whelher specified herein or not.The granting of a permit does�ot presume <br /> lo give aulhori to violate or cancel Ihe provision of any other state or local law regulating construction or th��pertortnance of <br /> conshuction. hat I am authorized by the owner of lhis property to periorm lhe work for which application is made and I comply with the <br /> Slale Contrac r�'�;�w 18.27 RCIV and 2�JG.200 WAC. <br /> / /7 j/ <br /> /�` �i� <br /> Signalure of' er/CoNractor/Authonzed Agent Date <br />