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P�RMIT APPLICATI(�N <br /> CITY OF EVERET� PERMIT SERVICES � l <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810— FAX 425-257-8857—www.everettv.�a.org �/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS AR�NOT ACCEPTED <br /> SITE ADDRESS PARC�:L TAX I.D.# PE MIT# <br /> y.� S . � s �� Ytf30o �Gdo / <br /> LEGAL LOT NO. BLOCK TRACT �� ,, � <br /> OESC. � �—O4•��e�, <br /> OWNER ADDRESS CITY2IP PHONE — <br /> �4D /��/ C�+-� �Gc. ���yl'S'/o C��.�•e `!'SZJ` ��[�-3 �i-'f6c�`E <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I T-�� �� — 3�� —�.zq— �9� 3 <br /> NTRACTOR ADDRESS CITY2IP PHONE <br /> 40/���Gu.�G�.c /'',/.1�9/U <br /> CO TR.LICENSE# ��7 <br /> '/}�C'/.'GL'�f U�2 LQ C.x.�� 4J•1 752�6 3'Ca�Y/-`f6� { <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � <br /> ,S.,vi, � ��,Z� _Electric 'i� Gas_Other 9� <br /> � QUc� <br /> WORK DESCRIP710N <br /> �.pYGa�Zc��t�� �ic,• � G��-w�; �cu-��� �I / <br /> J � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-airhandlingunits <br /> 2 Bathtub -� Forced air systems <br /> � Lavatory (wash basin) T Gas i m <br /> P�P 9 <br /> Shower ,�, Waterheater <br /> % Kitchen sink 8 disposal f Gas fireplaca <br /> � Dishwasher � Gas range <br /> / Clothes washer / Clothes dryer <br /> _ Laundry tray � Range hood <br /> Sink(service/badmop/etc.) .3 Exhaust fan <br /> � Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> ! Floor dra:n Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> I <br /> ICITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> iI 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 /> iordinaces governing this type of work will be complied wilh whether specified herein or not.7he granting of a permit does not presume <br /> to give au!hority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> ' Staie Contr�tors L � 18.27�t ayd 296.200 WAC. <br /> . <br /> I ,-�� ��'�-�i� � - y-� 7- os <br /> ISignature of OwnenCon ractor/Authonzed Agent Date �%2 � <br />