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�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—uwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /�3i5 /9'� l�aE s, 0o5755aonoodoo <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .l�.P �'o/�ec.� Tr�c y O.DS I �06 �.S'9�1Ko H.ZS �3z-6 6 y 7 <br /> CONTRACTOR�ncA.� �D/ ,�,� �.'nrL ADDRESS pD 6oy� /5/`f(� CITY2IP PHONE <br /> p �.cf�c ✓al/s'1 <br /> CONTR.LICENSE N <br /> ,c��A��«�3,�9 � a3�o� w�, 9�0;8 y1s-y3z-GGS`7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other 3� �+00 <br /> WORKDESCRIPTION P��,,,6,:7' f'6�2 Q�N�R< o�� '[E l�i�n.,-�' i�yjo�n�""�"`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 2 Toilet A/C—air handling anils <br /> Bathtub Forced air systems <br /> 5 Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> �� Kitchen sink 8 disposal Gas firapiace <br /> Dishwasher Gas range <br /> Clothes washer ':lothes dryer <br /> � Waler heater _ Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> L_ BackFlow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain _ Refrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains Other <br /> i.• Otheror�vr�� �7i2 <br /> S 17ENt?� �Atu��y — <br /> S N.,r=r5 Oki.d� <br /> ✓"� �r,y�"'� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this applicaGon and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governirg lhis lype of work will be complied wilh whelher s�ecified herein or not.The granting of a pertnit does nut presume <br /> to give authoriry to vioiate or cance�the provision of any other state or local law regulafing consWction or the perfortnance of <br /> construction.That I am aulhorized by lhe owner of this property to pedorm the work for which application is made and I comply with the <br /> State Conlrectors Law 8.27 RCW nd 296.200 WAC. <br /> �,G ,� /-za � o�, <br /> Sigrrture of OwnedContractor/Authorized Agent Date <br />