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��ERMIT APPLICAI �0lV � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX(.D.# ERMIT# /I <br /> ys � -�h. - 3 /z9os3oo ��o � ��'� - � <br /> LEGA LOTNO. BLOCK TRAC�T _ <br /> DESC. l� �p(�,�� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �¢0 �� (�z,ee.('11 c �°��.x 9/0 ��, �z3� 3�o-3g/-�6o5� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> � �-�-•, .��0 9'zQ -i9,�3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �'4d �.�✓ ��"QL�c <br /> CON R.LICENSE# <br /> �AF, /rCL�c o /Z </� �'/aa'xy�� , ���� 3��.���- ���v <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ ? I _ElecMc �Gas_Other I 9� Op O <br /> WORK DE�CRIPTION � ���(/m,(�1 NG GiQDUd/17 R�C�— <br /> //�-✓ /�7�cu� ����� �o•Uc�P£T� SGrJ.CS/w %V 59t�9Tiv�fJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> oilet A/C—air handling unils <br /> fSt b d air systems <br /> -L�veteq(wash basin) � Oas-piping <br /> Shower � rheater <br /> � • en sink& disposal � fireplace <br /> � Dishwasher / L',astange <br /> - othes washe- 3 IoUies dryer <br /> Laundry tray age hood <br /> Si�k (service/badmop/etc.) {yd�aust fan <br /> �-Backltow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> �-f�6ortJrain Refnge2tion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX COCE IS 3105 <br /> I hereby cerilify that� have read and examined this application ar�d know the same lo he true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaling conslrucUon or the performance ot <br /> construction.That I am authorized by the owner of this property to per(orm the work for which application is made and I comply with the <br /> Slate Contr rs Law 18.27 RC 296200 WAC. ' <br /> �G��c j����� 1 -;�s-0 5 <br /> Signature of Owner/Co tractor/Authorized Agent Date <br />