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F��RIV�IT APPLICATIVN <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FPJ:425-257-8857 —www.everetiwa.org �_.Z� �� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI1 E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �d`)� �`(+�' /q�c>_ � .;L�S��'iCC� l O��J E�G� S� Cl7-UC�`� <br /> LEGAL LOT NO. BLOCK T�ACT I <br /> DESC —�c'� G�tG'�I �IC 'f 7� � E':'T �� <br /> OWNER ' A DRESS CITY2IP PHONE <br /> l�cc5c� � �Czcc ��C� 371`( 103�`STS � �vPlc"H" I.�Q �?Av C��.�5�337-03:5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��r��19��. �cc�0�� -r �a�/ �/1�� �t�r.�S�10(SIt2S G�'.1�1� �'�12J)�7�-'u�3�j <br /> L f k <br /> CONTRACTOR ADDRESS CIN21P P ONE <br /> .�e�r�r N�'��.n � �J.ti S��-�2,.,..5 (�u5 77G- �frS� S <br /> CONTR. ICEN SE# <br /> 6�RRl��uG�% 77cM -7`/G�O N4r��>so.� Rcr� E�.:���f3, c�A S�� 3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.�.��'G� _Eleclric _Gas_Olher �' `� �y�'--� I <br /> YVORK DESCRIPTION 1 1 /� -1�1l I <br /> F / � �. ;.�S�tc<� � .'IL.9-f�T Wc. � � 5���.� wi��� �jr/ lnC�i,Vi�l✓4� I"UG �C9T��l5 O�\ <br /> C<W.7�1 CCt�C � <br /> a (�c,��+-��� s�lv,� ,'� �.�. Lx�, (� yrc���.,d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR ITFM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash b;isin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Cishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water heaLr Range hood <br /> _ Sink(service/bar/mop/elc.) _ Exhausi fan I <br /> Backflow preventer Heat pump <br /> Urinal Unit heater � <br /> Drinking Fountain Boiier <br /> Floor drain Refrigeretion <br /> Grease trap Woodslove <br /> Roo(drains Other <br /> Olher _ <br /> CITY OF EVERE'•T LOCAL SALES TAX CODE IS y105 � <br /> I hereby cerilify thal I have read and examined this applicalion and knuw the same to be hue and correct. All provisi�ns oi laws and � <br /> ordinaces governing this lype of work will be complied with whelher specified herein or not The granlu�g of a permil does no!presume �, <br /> to yive aulhority lo violate or cancel Ihe provision o(any other stale or Iocal law regulating construcGon or ihe performance of <br /> consiruction.That I am aulhorized by�he owner of his property to perform the work for which application is made and I comply with the <br /> State Co Itectors L�iv 18 7 RCW anc}296,200 AC. <br /> 1/ � �` � <br /> �rCc �/l6,'- � ' ������t� � � �,)�1�� s-�D� I, <br /> i�ure ot Owne onUe�dAulhorized Agenl Date � � ' <br /> l U <br />