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f�cRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STP.EET, EVERETT, WA 98201 <br /> 425-257-8810- FAY 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# � <br /> ,' l�' �. p � i. _ _�, - _ �6 � ` �C7 <br /> LEGAL lOTNO. BLOCK TRACT <br /> DESC. `� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �o�� �N �k:\�,, �� i�M,.e,A�k: A�� C.J�Rv'Ct 4,8:�a� (rl ���a`1�- 3yS <br /> TENANTNAME CONT CTFORPERMIT PHONE � <br /> �wM�— ��f� �73 7 4�// <br /> CONTRACTOR U�� V z f ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> >�^ �N ,,��� _Electric�Gas_Olher <br /> WOR ESCRIPTION- �7 <br /> ,, � ,.�.,�� �^C.�.��,��, ,,,,�,� a,��G,�S? �.-.��. . �� / <br /> C�.,.:,+�.,.� s � C , � <br /> �� 9 <br /> PLUMBING MECHANICAL <br /> NO. TYPE GF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� l"oilet 1i A/C—air handling units <br /> �� BathWb i/ � Fnrced air systems <br /> �� � Lavatory(wash basin)!x�1 � Gas piping <br /> Shower ; Water heater <br /> 1 Kitchen sink&disposal Gas freplace <br /> T Dishwasher Gas range <br /> �_ Clulhes washer Clothes dryer <br /> �_ Wat�r hoaler / Range hood <br /> _J_ Sink(service/bar/mop/etc.) � Exhauslfan Jf%(/ <br /> Backilow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritify that I have read and eaamined lhis application and know the same to be lrue and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a pertnit does not presur::e <br /> to give authority to vioiale or cancel lhe provision of any other slate or local law regulating construction or lhe performance of <br /> construction Thal I am aufliorized by the owner of this property to perform the work forwhich application is made and I comply wilh the <br /> State Cont�rs-6�w j�7 RCW and 296.200 WAC. <br /> ��%--! �! (.l�� � / <br /> Sig� ure of OwnedContracrorl ulhorized Agent Date �(� � �G G� <br /> �� ��Z <br /> i <br />