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S -4-0(d <br />HERMIT APPLICATION <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 PM k L)U05 -DOL <br />SITE ADDRESS %rZ 5- -75 ST; , 5I J <br />PARCEL TAX I.D. # <br />PERMIT # <br />F_4rerfzr_T-r 9Lp3 <br />JI- <br />LEGAq LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONNE�, <br />p <br />�"r4 1 moor -rlrs� PO E��C :5 ZSS EJI=-Rr--=' 9BA �fZ!s -q3a -`ill <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />COFF <br />I 1wt �y i `�83 -SAS 7 <br />w�Ar <br />-� ✓-11E�JA.ei <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />a4D�I11.JGF—A I'12G �TF_�7'f n•i pn �,� 1-�N3 tJnn�I��Iurs � <br />CONTR. LICENSE # <br />�,:44rJ F F 1 q9 66 <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />JAaF-N <br />Electric <br />(0.3oc <br />ori' <br />__Gas _Other <br />-0to <br />-4 <br />WORK DESCRIPTION <br />To I.1G �Or K f}APtT lvinl. <br />Am PRdYtTro, l /JFvJ 30yt(ef'i <br />fLO/}O <br />F-*Tr--+�1` C'A OF �ycIST7�(�.st�57ErV1. CZ"T roTAL SPIZri-IKLG-(L ry QSJ <br />` <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Nrl. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — airhandlingunits <br />_ <br />Bathtub <br />_ <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_ <br />_ <br />Kitchen sink & disposal <br />Gas fireplace <br />Dishwasher <br />Gas range <br />_ <br />Clothes washer <br />Clothes dryer <br />Water heater <br />Range hood <br />_ <br />_ <br />Sink (service/bar/mop/etc.) <br />_ <br />Exhaust fan <br />_ <br />Backflow preventer <br />_ <br />Heal pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />Boiler <br />Floor drain <br />RefdgeraWn <br />_ <br />_ <br />Grease trap <br />Rcof drains <br />Z'3 <br />Woodstove 1 <br />Other �Fi2i. LlcLE2 005AO�--' <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with 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 regulating construction or the performance 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 />State Contractors LaW 18.27 RCW and 296220U WvAC. <br />Sig lure of owner/Contractor/Authorized Agent Date <br />