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P�RMIT APPLICATILN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org Ol� Sa�-�� <br /> ! <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.i� RM}7 � <br /> � ,� i l /��� - - - b� ".�� <br /> LEGA LOTNO. BLOCK J�A�C f �jn� �d�� � , <br /> OWNE,R � a `"" I' �'.0 � .� <�[Q�3f� �if�li �1,mIFS/V��If J/� ��� <br /> ADDRESS CITY:LIP �pF{� E <br /> .75-.�25�7-//<7/� <br /> l�tti��i� �,Uo /S�o�/ / rI�^,ys�u�v �i.r��/�� 9�.�n i <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> ����/�- I Ur�v,.� LA��G� Y.�s,�y�/i.�a� <br /> CONTRACTOR RL`1� Eti�����j�S ADDRESS����!/ �3yj75`r�(jLCITYl71�� S PHONE � <br /> CONTR.LICENSE# _J)����/�� //�� `��}^ �y�/'� <br /> �Lfr 1 r_,.� � <br /> USE OF BUILUING HEAT SOURCE CONTRACT?RICE OF WORK <br /> ��/.'�iJy'.G df�>icrS <br /> �Electric _Gas_Other /7� as/t�/ � <br /> WORK DESCRIPTION A7. $JU/J� �y.1�0i Cz�. y`z� ,�yi5i`/�,�y �Gcc/f�y'jv�� //70 Sfi i�T N.F%u <br /> �•rtt� A Nlcv �/,3i3�� �'oo� ocY.c �v<<v � o/tP� is.t.Cti/ A .�i�.0 /� •� Sid.� sl.ur•�, <br /> �Zj �,f' � /t/�u� �Y/s� ��` �/w I� 7�'1Zf'�� �l'L7�{s�j.� /ui il d(. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas pipin� <br /> _ Shower Waler heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher as ranc�e <br /> _ Clolhes washcr C s dryer <br /> _ Laundry tray Ranc�e od <br /> _ Si rvice/bar/mop/etc.) Exhausl(a <br /> _ Backflow p ter � Heat pump <br /> _ Urinal Unil healer <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration \ <br /> Grease lrap Woodstove � <br /> � Roof drain �� Other 1 <br /> ,� Other `i r�� — <br /> 2 U-L — <br /> �^�cF Sr���. 'f�Lr�l-, � b�1�v r � — <br /> CI OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify thal I havo read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinace verning this fype of work will be complied with whether specified herein or not.The c�ranling o(a permit does nol presume <br /> to giv aulho 'ty to violate or cancel lhe provision of any other state or local law reguiatinc�construction or the performance ot <br /> con ruction That I authorized by lhe ow r of lhis properly lo per(omi lhe work(or which application is made and I comply wilh tlie <br /> St te Conl�ctor� j8.27 and 296 00 WAC. / <br /> itrY��� � �S- <br /> S��o Ow er/C a r/Auth ed Agent p i/L <br /> � <br />