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PCRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3290 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> ��� 7 APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a �, a-o 7 <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT K G� <br /> ��j4�f-�S�'1-t �1��- !�l C . , �G�, !' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. S.S•5���-"'S � <br /> OWNER ADDRESS ITY IP PHONE <br /> .p gu�e 5 5 <br /> �i�� Srvu.�r t �tv��-r� t�T-- ��� ���h 9zs-2s5- yy5 <br /> TENANT NAME I COP�TACT FOR PER T PHONE <br /> �Y� h� c�Nu Fr.�r u,�-i�l 4�E�� �ewu�,.,o �z�� -255 44 S5 <br /> CONTRACTOR ��1R-1t7C OC_►2hWFcvLD AUDRESS,4$2-1 ryH�l� cv2�I�P`� PHON�S Zq� ��Z <br /> / <br /> G �� f <br /> CONTR.LICENSE N �f A�� � 1��L. / _ �/��/� �g � 3 <br /> �� F�17 j e <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> �.t,p�on,riN <br /> ��u���.,u�� � U�'�l ^ _Elr.ctric �Gas_Othor �� �� p '�-Q <br /> WORK DESCRIPTION <br /> AQD oF�iceS Ar w1C2Zl�� �'�t Lev� <br /> w �m �w� I l��bi n,a,,, �t.. 6fG �� u?�. <br /> PLUMB!NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. IYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> 8athtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Showcr Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler liealer Range hood <br /> Sink(service/barlmop/elc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Iha�I havo read and examined this applicalion and know lhe same to be true and cortect. All provisions of laws and <br /> ordinaces governing Ihis�ype of work will be complied wilh whether specified herein or not.The granting o(a permit does not presume <br /> lo give authority to violale or ancel lhe provision of any other stale or local law rec�ulating conslruction or the performance of <br /> conslrucf�i Thal I am aulh�i'zed by lhe own2r ol this property to pertorm the work for which application is made and I comply wilh lhe <br /> Sla Co �lra ors Law 18.27 CW a 2 .� <br /> ��,� 'z...._ I - l P� - Zvo'� <br /> Signature of OwnedContraclor/Aulhonzed Agenl Dale ' �.. <br />