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r�ERMI�' APPLICAI �ON <br /> CITY OF EVE�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WP. 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# / <br /> s��l T.S, Sl, �E. 3 /.z 90 r 30o y�Go � `� �-- � ��d <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �C �� ��' ' <br /> OWNER A�ORESS CITY2IP PHONE <br /> �¢� l�� C��t'�c c r"o�,� yio C���, s�Z3� 3Go-3�i ��av� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> _ ��-�'v� �-�., .��v P'z y -��.�� <br /> C�¢lj T j%'� �LL � AOORE55 CITY/ZIP pHONE <br /> CON R.LICENSE X <br /> �A F rc��c o �z </� �"/o�-x 9�� C��, 9srZ�� 3�U.�'��- ���v <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5�,� r4�'�`5 �2�1e�.7 —Electric �Gas__Other 9�L OO � <br /> WORKDE�CRIPTION � ��(�m,t31NG G�QOU�i/A RI��– <br /> ��,� ��cu� ��'_�(�;o.�t/c�Q�T� SG��.C3/w �,vsycwT�o�d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 01 A/C–air handling unils <br /> - Bathtob _� 6urcedair-sysEems <br /> _ Lavatory(wash basin) � �a�����9 <br /> _ Shower � -Waterheater <br /> itchen sink&�isposal sf replace <br /> �-Disnwasher Gas-renge <br /> �-GlothesWasher -8falMestl r � <br /> _ Laundry tray � Range hood <br /> Sink (service/badmop/etc.) �-Exhaust-fan <br /> � Backftowpreventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _-Floor drairr Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> = Other I = <br /> CITY OF eVERETT LOCAL SALES TAX CODE IS 3'105 <br /> I hereby ceritify that I iiave read and examined this application and know the same!o be true and c�rrect. All provisions of laws and <br /> ordinaces goveming lhis type c f work will be cemplied with whether specified herein or not.The grenting of a permit does not presume <br /> lo�ive authoriry to violate or:ancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am a�,thonzed by the owner of this property to perform the work for which application is made and I comply wilh the <br /> State Contr cpors Law 1E.27 RC 296200 WAC. � <br /> - �-- �-:25= �'.� <br /> Signature of OwnedCo tractoriAuthorized Agent Date <br /> ��Z�Z -D/� <br />