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� <br /> ( __ � _-- —, <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, FVA 9820? <br /> 425-257-8810- FAX 425-257-8857-ww�v.everettwa.org <br /> . . APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT&CRED!T i:ARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE/RMIT# <br /> �'� - .c - �c.i� !b CZ ?' O �� :��C 2.Oi b� i � �l�`G��� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESG � � _ AT('f�(.;� I <br /> � OWNER AODRESS CITV/ZiP PHONE ���ZL ��,Q.W-.� <br /> _�� <br /> 1�-'L'77� 4�d 7-�'riFs /w I`f`!CC /4`-IZ� AV= rJt- [ ��c �nv �� i✓A 9f'��-�7.I <br /> TENANT NAME CONTACT FOR PERMIT PHONE . <br /> � lZ�)S�`i-G35t- <br /> �, ,� . k,�z. �„ .L s�c� n�t�a cs � <br /> �� CONTRACTOR ADDRESS CITV/ZIP PHONE (�-17.5 ';�5� -Sl���-- <br /> � `�iE�.v.n i'.-c.-�-rsrw.�...-i�..i IY�i��t 1�14�` - Pvie �fc�, 1��:.a.�v.�e.�-� I.�r� `!£�.���Z <br /> �I CONTR.LICENSE# <br /> �C¢-�2CC l�l5 9b <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas_Other � /C{j OCX->- � <br /> � CFNC.0 h mz.a � ' � <br /> �� WORKDESCRIPTION ^ c /�.W �rJyP�-IT I�'�1�r7�C✓L��'1c-�`+�/y �^'/ /�/r^> - NP�/ <br /> �. ('cv-.��nn:�s <br /> �X�.H`,`� "��i�r2.�Ai.✓_ G- CTrItF'�, <br /> ' PLUMBING MECHANICAL <br /> ��. NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �I Toilet __ A/C-airhandlingunits <br /> � Bathtub _ Forced air systems <br /> � _ Lavetory�wash basin) � ��.,���y,� �,qpu� — Gas piping �� V��Dv2 SC A(✓-'�'f� <br /> I Shower _ Water heater <br /> ' Kitchen sink&disposal �������n�iT _ Gas fveplace �t'i2.Wt 11 <br /> � Dishwasher _ Gas range � <br /> �� Clothes washer _ Clothes dryer <br /> �� Laundry tray _ Range hood <br /> ' Sink(servicePoar/mop�etc.� _ Exhaust�an <br /> � Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> �, Dmking Fountain _ Boiler <br /> � Floordrain _ Refrigeration <br /> . Grease trap � Woodstove <br /> �� Roof drains _ Other � <br /> � — O!her_ . I — — <br /> i <br /> CITw pF EVERETT LOCAL 5A1E5 SAX COOE IS 3705 <br /> �� I hereby ceritify that I have read and examined thi;application antl know the same to be true and correct. All provisions of laws and . I <br /> � nrdinaces goveming this type of work will be complied with whether specifed herein or not. The grantmg of a permrt tloes not presume . . <br /> to give authoriry to violate or cancel the provision of any other state or focal law regulating construc[ion or the performance of .. <br /> ronstruction -i hat I am author2ed by the owner of this property to perform ihe work'or wMch application is made and I comply with the <br /> State Contractors Law 18 27 F�CW and 296200 WAC. <br /> �— � / z � �: <br /> Sign _ of�wnedContrado ut orized Agent - Data — � <br /> `3 <br />