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PERMIT APPLICATION <br /> CITY OF EVERETT PE�iMIT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org /D -aJ-o� <br /> I�DD /3-� �"�PPLICATIONS AflE ACCEPTED FROM 8 AM TO 4 PM J� b gog _Ob� <br /> SITE ADDRESS PARCEL TAX I.D. tt PERMIT N <br /> -I�l ��i��' $t' • O SS' (o -Ooo 'OD ' Oloz O O -OoC.o <br /> LEGA L0T NO. 6LOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ?P�oviDEUC_E �tiFe�Tr NnE.P GTrL, i321 C�PL&4�vE - EvEReT( �SZolv �42.5�2b�-455 <br /> TENANT NAME CONTACT FOR PePMIf PHONE ZS��.�i.3��L� <br /> TH�ERo�� DeV�S E•A7All—I��ar.-�E-��r�<_�e zu,esr, <br /> CONTRACTOR ADDFiESS CITY/ZIP PHONE �A.M <br /> FiR-E SysrEMS tc�EsT 2� G��rnc�E RD c.iFi�- wt+ <br /> CONTR. LICENSE p � �A � 253-8>3-I"L 4$ <br /> � FiQ�Swi 14t�Bi S�t�i E L �/5��� <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ; h�l E p� L4 L _ELciric __Gas___Other � 2�oea�o oa <br /> � WORK DESCRIPTION <br /> � lNS'TA� h1EW F!e..r. SPR�-ir�K-�c(L S�/s'Y�MS A"r LEVE�-5 2� 3� An�D 9- <br /> ' I� �e� 1 Z r-`oo f� 6�n�-, . <br /> IPLUMBING MECHANICAL <br /> iNO. TYPE OF FI%TURE OR ITEId NO. TYPE OF FIXTURE OR ITEM <br /> I' ToiIM _ A�C—air handling unils <br /> � _ 9alhtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Showcr water heatcr <br /> Kdchen sink&disposal _ Gas(ireplace <br /> Dish�vasher Gas range <br /> Clothcs washer _ Clothes dryer <br /> Waten c�aler Range hood <br /> Sink(service/barlmop�etc.) [xhausl fan <br /> Backllow preveMcr Heal pump <br /> Urinal Unil heater <br /> _ Drinking �ountain _ Boiler <br /> Floor dra�n _ _ Relrigeration <br /> Grcasc traF � Woodstove <br /> - Rootdralns 19]0 ou�er. 'FlE�SyR,t�„1jC.l��t.. <br /> Other -._. — __ <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and ezamined Ihis application and know Ihe same Io be tme and correct. All provisions ol laws and <br /> ordinaces goveming this type ot work will be compGed wilh v:hether specilied herein or not.The granting of a permil docs not presume <br /> lo give aulho�ity to violate or cance e provision of any other state or local law regulaling consiruction or Ihe pertormance ol <br /> consiructiro.Thal I am auiherize ihe owner of Ihis property lo pedorm ihe work lor wh�ch application is made and 1 comply with ihe <br /> Staie CoNrac�ors Law 1827 R and 296.2G0 WF�C. <br /> 3�1 I o 9 <br /> Signaturc of Owner/Contr �odAuihorized Agent ate <br />