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P�RMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEC 4R STREET, EVERETT, WA 98201 <br /> /b3� 5 /q SC 425-257-8810– FAX 425-257-8857–www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 GREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS B�a� . • PARCEL TAX I.D.# PERMIT# <br /> i���'5� � 9'�'` Ig ve . S . E . o0 7 0000o boo I f l ��o� - �'o/ <br /> LEGA LOT N0. BLOCK TRACT � <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> d � y$�3 3 <br /> (Y�R3 �CJeIoPm�ht 6�as //6T" A�c �IJ•E. loo e��ak�a,.d Ya,S • 8aa • yy66 <br /> TENANTNAME CONTACTFORPERMIT pHONE <br /> S� IJ[r� IAF-e I�e� �cs� l I p� a.n�e �7 � n�an ;36o , b51 - 7�0� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Sr+�fti F�R� SyS�e.mS 3813 ! 6 �'h sa. N��, �Q <br /> CONTR.LICENSE# /' �� '��j'�'o'� <br /> S,,;t � I 9 � a� � 360- 65l- ��a � <br /> USE OF BUILDING I — HEAT SOURCE � CONTRACT PRICE OF WORK <br /> rn �e c�i C A � ��� ��e Electric Gas Other 3 I� y?� � <br /> WORK DESCRIP710N <br /> .YnS} all 7��(Le SPR� nl� len. S� j �a� � � �o �/ NeAc� 3 , <br /> PLUMBING MECHANICAL � <br /> NO. 'R'PE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handl(ng units <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wasn basin) �as piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/baNmop/etc.) Exhaust fan <br /> _ Bar.kflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeretlon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other -- ' <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> � I hereby ceritity that I have read and examined this application and know the same to betrue and cortect. All provisions of laws and <br /> iordinaces goveming this type of work will be complied with whether specfied herein or not.The grantlng of a permit doex not presume <br /> to give authoriry to violate or cancel the provision of any other sta[e or local law regulatlng construction or the perfortnance of <br /> ( construction. That I am authorized by the owner of this property to perform the work for which applicaHon is made and I pmplg with the <br /> IState Contractors La'�wI 18.27 RCW and 296.200 WAC. <br /> � �(�-a- �G�,a,,.�.. I ' y • O S <br /> I Signature of Own r/ContractodAuthonzed Agent ate <br /> I <br />