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PtRMiT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, \NA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � (� �-�� <br /> SI�t�(.v E�J�� I��/P��� r'• 1l�I O.y PARCEL TAX I.D.# P/yj�p3 3s <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> 0��. G 13z I�DC616y Av? l..VPVITM� C�$z0/ NE <br /> f7 <br /> TENANT NAME CONTACT FOR PERMIT PHON�� � ) ��y,yb <br /> � 1 I/ % <br /> '�F.1��. �tnC\i�'J�� �Q1rf11� E-MAIL <br /> CONTRACTOR � ia�o ADDRESS / ^ CITYIZIP PHONE <br /> � � �n5�4t,�rS '3�1i'.�J� !t�r�or'� Lr ,�/Ii�x�, han� C3F.U� <br /> CONTR.UCENSE t! D=A m b�3 G o�61�,q /O zz � 73y— '36� <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> �2.CJ 1(�� _[IecUic _Gas_Other „�Fi cX�� • � <br /> WORK DESCRIPTION ���� 1 �«,� <br /> �o� k�cjS-�i �� �vc,�Wor{� � �¢,-cc�"P New w <br /> �� bP ��, a��;'h.�P �,`�G� � 5-�-�-�`-sysfa� -�� �„�.5��� �y�� <br /> PLI;MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W aler heater <br /> Kitchen sink&disposal Gas(irep�ace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water haaler Range hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> Back(low preveMer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby reritify lhat I have read and examined lhis application and Inow the same lo be true and correcl All provisions of laws and <br /> ordinaces governing lhis lype o(work will be complied wilh whethei speci(ied herein or not.The granting o(a permi�does no[presume <br /> to yive aulhority to violate or canr.el Ihe provision o(any olher sta�e or local law regulaling conslruction or the pedormance of <br /> conslruclion. That I arti authorized by lhe owner of lhis property to perform the work for which applicalion is made and I comply with the <br /> Slate Conlraclqrs,Law 18.27 RCW and 296.200 AC. / <br /> ��� 3 2 o c.�' <br /> SignaWre of OwnedContraclor/Authorized Date � <br /> � <br />