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PtRMIT APP�.ICATIC�N <br /> CITY OF EVERETT PEI2MIT SERViCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 ?j.-7'—� g <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �\� PARCEL AX I.D.# RERMIT# <br /> o �� i�t' A��S�- �ta3o�-C�o - LoS�oo ,� � &v3 -003 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> S li`'1 p �--L C— ,,i..�1 lC�ti� w � �l ��5�— <br /> TENANT NAME CONTACT FOR PERMIT PHONE C ,z����� 3 C/(� <br /> —7 <br /> F� — �—`-�___ �.v ' \ E•MAIL <br /> RA ^ � � A��S TYI IP PH G <br /> '—� l� \ �e �-�r�t �—�ilc �(`c5<<CT ia� ��t.�� W '�l� IZ �� �� �0 ( � <br /> CONTR.LICENSE p � <br /> ' �-s����'�k'llz <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> n ��' � _,Eleclric�Gas_Other � . ��� <br /> �C \ <br /> WORK DESCRIPTION � IvS S <br /> � Q.x, Sz �.�q <br /> /�i�� ne��..� �,��c�S o v <br /> � <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM �. <br /> Toilet _ A/C—air handling units <br /> Bathlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> � Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodslo <br /> _ Roofdrains _ Olhar —�� �^��'f' (� �L� V� <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify thal I have read and ezamined lhis applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces yoverning this lype o(work will be cor,iplied wilh whelher specified herein or not.The granting of a permil does not presume <br /> to give aulh ry lo violale or cancel the provis;on o(any other state or local law regulatinc�conslruclion or the performance of <br /> constructi .Thal I am authorized by the owner of lhis prcperty lo periorm the work for which applicalion is made and I comply wilh lhe <br /> Stale tre ��v 1II.2 CW and 296.200 WAC. <br /> � —S—d$ <br /> alure of OwnedConlracbdAulhorized Agenl Date <br />