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P�RMIT A�'PLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CECAR STREET, FVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM y � a p—O-r'y <br /> F <br /> SITE ADDRESS y� PARCEL TAX I.D.# PE j'�# �� <br /> ll o� / 9� ��� �. i��T <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION ri <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C,UGS� I fca/�/`� .,2>� —ST� <br /> TENANTNAME / CONTACTFORPERMIT PHONE <br /> �C� /��l��t u�aJ'Q E•MAIL <br /> CONTRACT R //�•� A09RES e1 I pZIP'�rf E <br /> �' aFFo�� WNS�-�r1C �'/OS //Ooa�t.,'o� �/. /�a'-`�J J�S'35����GG i <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � <br /> ��'�,�, l _Eleclric _Gas_Other ��� G� <br /> WORK DESCRIPTION/ /� ) / / r� /�r�,� �' r�oo�� <br /> fYo� �>�I 4 1C.,-�� F, �:r� �X� 'Nf�(S. .coCk. .,,� o��cs a rs� J"l <br /> N�� �%�R� a�«. <br /> PLUI'ABING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Teilet A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clolhes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/mop/elc.) Exnaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true�:.d correct. Ail provisions of laws and <br /> ordinaces governing lhis type of work will be complied with v✓helher specified herein or nol The granting of a permil does not presume <br /> lo give aulhoriry to violale or cancel lhe provision o(any other slale or local law regulating construcGon or the pedormance of <br /> construction. That' am authorized by lhe owner o(this property lo perform the work for which application is made and I comoly with lhe <br /> Stal Conlractors(_aw, .27 , W and ?Qf,700 WAC. <br /> �� ��-�� =, Y ao-o <br /> � ig�alure t- nP;F/Co� clor! uttSorized Agent Date (� <br /> � <br />