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P�RMIT APPLICATIdN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS I PARCEL TAX I.D.# P R��# <br /> 8'�S Co�5 /�,x. �w..� ,wR 9� I cx�I 19 I 66 7�i a�o ,� -- /� - �-5�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. ' �V 66-1 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��„�;« �...K 33�. Cw-.1�},,,,,.q, �,,�y �.,.R 5�'zo�l y�5'•sv7-o6w <br /> TENANT NAME CONTACT FOR PER PHONE <br /> F�w.1�ir �„^ I �Ja�t Fb.M�r« J6o' �i.7�" ���� <br /> CONTRACTOR ADDRE55 CIN/ZIP PIiONE <br /> Cr.�� fJo•Vawu4 C�^���+u� �S:�V S�.k<��1. 61a1 �11<���l�c� ��J1�1 3(>0•65�•111�' <br /> CUNTR.LICENSE p - <br /> C��CS-i- Nc•v53•k� �- !'_- 07 <br /> USE OF BUIL741NG HEAT SOURCE CONTRACT PRICE GF WORK <br /> �mn..1 ! h.ti�J <br /> _Ele:tric _Gas�Olher <br /> WORK DESCR('IPTION I' <br /> �� UFC.t♦ H�^I��G^. <br /> PLUMBING MECHANICAL <br /> NO, TYPE UF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet AJC—air handling units <br /> �athtub Forced air systems <br /> Lavatory pvash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas Greplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/etcJ Exhausl fan <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinkinq Fountain Boiler <br /> Floor drain Relrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olber <br /> CITY OF EV[RETT LOCAL SALGS TA%CGOE IS 1705 <br /> I hereby ceritify that I have read and examined this applicalion and know the sama to be true and wrrect. AI�provisions of laws and <br /> ordinaces�overning lhis type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to giveauthority violate or cancel the provision of any other stato or loral law regulafing construction or lhe peAortnance ot <br /> wrt5truction.Tha 1 am aul�l n�the owner of this prcperty to pederm lhe work for which application is made and I comply wilh the <br /> (b�late Contracto Law 18.27 RCW ild 296.200 WAC. <br /> \._ / / Iz L Y o C� <br /> Signaturg f O�Conlra dAuthorized Agenl Date �/ <br /> / � <br />