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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �` l �P t �,� /�.�- /'� S � -/ <br /> LEGAL LOTNO. BIOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ����e�.�,-=� �N� R�. �x 37o-�j �-_�� ��''1� z�� �7�7 ��4�o <br /> IENANT NAME CONTACT FOR PERMIT PHONE <br /> Si7c czc+�r3�`'� I 5,��.t,������.�2. �(z�-7�S � ZS�/ <br /> CONTRACTOR (�j�,y����'CqrJ'�"T2.J�o+.� ADDRESS CITY2IP PHONE <br /> /cUO�j 2i21"+t 5j5uJ `i8o'�c <br /> CONTR.LICENSEp i-�.i(��/`1G '�"�33Z�� 3 � I � D-I �I,Ku)��D(� �'�'j'�'2S� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ����'-Y'�,�/wA�t��S��� Electric Gas,�Other ��23'�D� <br /> J � <br /> WORKDESCRIPTION �_��` G�u���� �,��r`'� iM4�Gt L.L,Vc'Z <br /> {�awl� Itit � ah- oF 5 1zo��-h� (�Oo2> c�.� �...�.:.STS1�:, <br /> CA%v �iY.1v� jD 4.(!�.(,C' �J�v.�Aa.J T � �A� '1"D t�1Ub �j�-(�� I�JSt� <br /> "j�2C �'IZC� �'�� �N� 2 = ��'^n7U�-'Gsl.{� ES ZOUnJ <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas pipinc� <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas renge <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(scrvice/bar/mop/elr..) _ Exhausl(an <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roo(drains Other <br /> _ Olher .— � <br /> — > — —T <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> lo give aut i y to iolate or cancel the provision of any other slate or Iocal law regulaling con;truction or the pedormance of <br /> ronstmcl' n.That I m aulhorized by lhe owner o1 Ihis property to perform thc�work tor which applicalion is made and I comply with lhe <br /> Stat Co tractors aw 18.27 RCW and 296.200 WAC. <br /> �� <br /> ( d <br /> Signature of Ow e ntra todAuthonzed Agent ate (/ <br /> Z <br />