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P�RiVll�f APPLICA�'lC7�J <br /> CITY OF EVERET�" PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /� \ <br /> 425-267-8810 - FAX 425-257-8857 -v✓ww.everettwa.org / O.C�/ �, \ <br /> l J�' <��l <br /> APPUCA'�IONS ARE ACCEPTEG FROM 8 AM TO 4 PM - DEBIT & CREDIT CARUS AhF' NCi ACCEP•rED <br /> � SITE ADDRESS PARCEL TAX I.D.# PER T� ', <br /> �v c ��7ti �� 31�9u53o �f�(�_� �i'� - 7 � <br /> �A�� LO NO BLOCK TRACT �, <br /> �ESC.� � � <br /> OIYNER ADDRESS ` CITY2IP PHONE c ' <br /> J Ca -� `f/ 'yG�c:� <br /> � � U PA R/r' C/F'EE/� ,[� � �,�� �/G C L/��fN,l.�A - /��s � <br /> TENANTNFME CONTACTFOR PERMIT PHONE <br /> I� . . • ' . �J�// /oR�_F �. ' � 'S= .`�`-Z� - � �"7 :�� <br /> CONTRACTOg � �.� � �N�� ���J ADDRESS CIT'/ZIP PFj.ONE <br /> �i}�.'� C,�- = .. • . .i tLa-3 �{/- '{6 o f i <br /> I CON LICENSE# / o /v 1� - <br /> �,��',�r_.�� a iz �� � ° � �y C� ��✓�`o�� �d,� �S z.�� I <br /> USE OF BUILpING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �/^/�,� E F��^� �y _=lectric �Gas__Other /� y G �j U <br /> NORK DESCRIPTION <br /> ' �p�v O � /�/�cJ Sii✓�L /_-' /r'h�v�i /� !� `=vE'�/i ��� <br /> i C � �.i s 7`iCk c�- <br /> _ ��.�,�� --�_ <br /> PLU(JIBING MECHANICAL <br /> ' NO. I TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 oiiet A/C-air handling units <br /> 2 Bathtub � Forced air systems <br /> � Lavatory(v.�ash basir) Gas piping � <br /> Shower W ater heater <br /> � knchen sink& disposal � Gas(ireplace <br /> Dishwasher � Gas �ahge <br /> � Clothes wzsher � Clothes dryer <br /> I � Laundry tray Fange hood <br /> �� _ Sink (service/bar/mop/etc.) � Exhaust(an <br /> � _. E3ackilow preventer �_ Heat pump � <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap Woodstove <br /> i Roof orains Olher <br /> �. _I Other _ _ -- <br /> I I <br /> CITY OF EVERETT IOCAL SALF.S TAX CODE IS 9105 <br /> I nereby centi(}� that I have read and examined this applicati�n and know the same to 6e true and c�rrecL All provisions of laws and '�, <br /> crainaces governing this type of work will ba complied wilh whether speci(ied herein or not. The granting of a pelmit does not presume ' <br /> :e cr:e authonty to vio�ate or cancel the provision of any other state or local law requlating constru�tion or the performance o( <br /> construction. That I arn authorized by the owner of this property ro perform the work for cihich application is made and I comply ,✓ith!he <br /> State )Contractors Law 18.27 RCW and 296.200 W'AC. <br /> . i/ =i%�%%�! � � ���. �- j -� _ , , . <br /> �._nawre ot Gwned omractorlAuthorized Agent � Dzte <br />