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. � <br /> � a — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—wuvw.everetiwa.org <br /> APPLJCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT b CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAl(I.D.N PERM17�t <br /> 16 c� tl- (3 t3�z�=������`; o � �/- 3 � �3 5 G o �`; o o S o� - acz <br /> lE LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER qDDRESS GIiY/LP PHONE <br /> 13e� ��ttr�,, ti� �r'�,��zcs �0:; � �+� � VE. � .23� � '.,E L£� 2 �6 – c� �/"iy - �� 7`J <br /> �tizl <br /> TENANTNAME CONTAC7FORPERMIT PHONE <br /> N r- iL r3 � � r,1c ;-�L,� �ss- �.� �.�n�,u���,� �cG -- 54-�— `3"�37 <br /> CONTRACTOR AD�RESS CITYILP PHONE ]o L-j'��a-�7 J 7 <br /> S �-�; i+-E Ly�iE SL(� N .�- R"^-r��C <br /> CONTR LICENSEi � �c��3 4- R ui�. R-R f��VE . n�'. 51-fv��t: (-..z,,�s� <br /> �)��•�vE S f}'1`S I S w q 4 f 3.� <br /> USE OF BUILDING HEATSOURCE CONTRACT PRICE OF WORK <br /> IZ'tiT�A� C.� I _ElecUic _Gas_Other I � `f�`� U �� � � � <br /> WORK DESCRIPTION <br /> I�C'E L c G H-T�- G XS S�-i.i (., .5 i'E��i>� L c-o L.... i�i ,v� l� N bw C,.: L�R-7-So..� <br /> /")It��n Fry-c.T�, �t,E �_. ;,r�s 77t � C, ll�r _z C L u�" L✓A—T�r� � iJ�3 �,., 4.r Sr � �/ <br /> ' PLUMBING MFCNANICAL <br /> I NO. TYPE OF FlJCTURE OR 17EM NO. TYPE OF FlXTURE OR ITEM <br /> e <br /> _ Toilet AIC–airhandlinpunils <br /> _ BalMu:� Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> , Shower Water heater <br /> Kitchen slnk 8 disposal - _ Gas fi�aplace <br /> I _ Dishwasher _ Gasrsnpe �i <br /> _ Clothes washer Clothes dryer <br /> _ Laundry lray Range hood <br /> _ Sink(service/bar/mopletc.) Exfiausi ten <br /> _ Beckllow preventer , Heat pump <br /> Urinal Und heater <br /> Drinking Fountain Boiler <br /> Floor drain ReBigeration <br /> _ Greasa trap Wcodstove <br /> Roof dreins plher <br /> OIhE� <br /> CITY OF EVERETT LOCAL SfLLES 7AX CODE IS 1105 <br /> I heiuby centify that I have read and examined lhis appiicatfan and know the seme lo be tnie and corteG. All provisions of laws and <br />' ordinaces gaveming this type of work will bo complied w8h whether specifled herein or not.The granting o!a permR does not presume <br /> to gWe authority to violale or cancel ihe pmvision of any olher slale or local law regulaling construqion or Ihe pertortnance of <br /> construclion.7hat I am authorized by the owner of this property lo perform tho work for which application is made and I comply with the <br /> State Contradors Law 18.27 RCW and/296.200 WAC. <br /> �� �. ;—�.ti./l .�./� 4� l v � <br /> Sgnature of Owner/ ontradoNAul onzed Agent Dale �i ( <br /> I G Z <br />