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l <br /> � ' <br /> � '''��a ��O ,y�'� PERMIT APPLICATION <br /> ���' � " " ��R `�ITY OF EVERETT PERMIT SERVICES <br /> ? ,��t��v� �' e 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ��"'Q�G 425-257-8810-FAX 425-257-8857- .vww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT• <br /> o l �r � d ����nZ�.� .��'�' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDREBS CITYIZIP VNONE ���3 <br /> �ansc.o 44oz zm�^Sr. �. `t<<ca.w� 9842C �'tz�--ZP4'i <br /> TENANT NAME I�TACT FOR PERMI7 PHONE <br /> .70�Ml� �S4w ka t���� �C�i �n��•�'�.7.�C� <br /> CONTRACTOR ADDRESS CRY/LP PHONE <br /> S��r�a Conyt'��ct�w 4z� <br /> �oN�r�Nt� 1 S lgqc� ta4t`'Av+�- laealuv�ll� �tL <br /> h�7- <br /> US�`BUILDI� �l�j — HEAT SOURCE CONTRACT PRICE OF WORK <br /> I Electnc _Gas_Other ���Q�I�('j <br /> WORKDESCRIPTION 3v��( ��- � A��q��y� ��L 5,+�� •� S��— <br /> ' 7 <br /> luarL�letlS� �unsJ�Rd1�, . <br /> _l�s,..l� �47 n.u. a.u. 1«ao�..�g �IGra�-s trths u.e���e.l�e�.'Y�G s�Aet�e. <br /> — ne... a�-T•aP��.r es..b. .e�f' e.� i! Id�..ec clercJr� d <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FI%7URE OR ITEM NO. TVPE Of FIXTURE OR ITEM <br /> Toilet AIC-air handling units <br /> Bathtub Porced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gas rarge . <br /> Clothes washer Clothes dryer <br /> __ Laundry tray _ Range hood <br /> Sink(service/badmop/etc.) Exhaust fan � <br /> � BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Bo�ler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains � Other <br /> Other <br /> C17Y OF EVERETT LOCAL 9ALE3 TAX CODE IS 9105 <br /> I hereby ceritify ihat I have read and examined ihis applicalion and know ihe same to be We and cortect. All provisions of laws and <br /> ordinaces goveming lhis rype of work will be complied with whether specified herein or not.The granting of a permit daes not presume <br /> �to give authoriry to violate or cancel the provision o�any other state or local law regulaling construdion or the performance of �,. <br /> constmction.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with the �I <br /> State Contracto 1�18' 7 W and 296.200 WAQ ''�� <br /> � l � <br /> tii � 06� �i �� I <br /> Signature of r/ContractodAuthonzed Agent Date �� I <br />