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P�RMIT APPLICATICyN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ' 425-257-8810— FHX 425-257-8857—www.everettwa.org <br /> 4 - ►I -o� <br /> APPLIC,aTIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �/U 5 PARCEL TAX I.D.# RMIT# <br /> l `� �lh r S� 5LD[a' OD � 0 C 6 O � S`� 7 -3 � <br /> LEGAL LO7'NO. BLOCK TRACT <br /> DESC. � 0/✓ C 5 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> /nac,��u� si7ua�.� iti�u�;;,�r P� �Z,�c /os9 ��l�oM�sNiia `iA�S� <br /> TENANT NAME CONTACT FOR PERMIT T PHONE <br /> -7(��o=,`=F;l-p3 l.P/IG/�n-���G� Je.e,ey DsaGziL-�t.. `H�S=7?Y��"(�/ <br /> CONTRACTOR ADDR_55 CITY2IP PHONE <br /> o�yr��7�� hu�a�«�� sN� ���.s-���=r��� <br /> (:ONTR�LICENSE# <br /> o[.�irn,or�r��ooi Z171d' ����'Alk3"i,✓. a07� I17ou/�cs�taTc�/�'-�./�1.� 9�Uti3 <br /> US OF BUILDING HEAT SOURCE C,yO.NTRACT PS210E �F WORK <br /> RG�(�IL O�F�C'C?' _Electric �Gas_Other "�,� (G�GQ <br /> WORK ESCRIPTION �5/qLL Z- 1ZwFTOp NdAL GcN�IS (.�/�T� (=iNl¢}-� / OU�Ldu2/G./ I <br /> L— Lsl:Nfl45I F.�/SJANO C�AS �'i�i/✓��(ZI <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet 'Z A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) 'L Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal + Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundy tr•y Range hood <br /> Sink(service/bar/mop/etc.) Z Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> I _ Roof drains _ Other <br /> I = Other = — <br /> � <br /> , CITY OP EVERETf LOCAL SALES SAX CODE IS 7'105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grant ng of a permit does not presume <br /> I to give authority to violate or r,ancel the provision of any olher state or local law regulating construction or the performance of <br /> construction.That I am authorized by the awner of this property to perform the work for which application is made and I comply with the <br /> � Slate C ctors Law 18.27 RCW and 296.200 WAC. <br /> I ����.r� � I� r�S <br /> Sign�S'dre of 0 er/Contract ,4uthonzed Agent � D�te � <br /> ; � L <br />