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', PER'MIT APPLICATION <br /> , CITY OF EVERETT PE <br /> RMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> � 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM II <br /> I�! SITE ADDRESS � � �i'T PARCEL TAX I.D.1f P RMIT N�7 � " I <br /> �LE���C1 , �rl� `�2C � � l�3 �`�OtJOUO�}-Dr� ��! O:S � lL' <br /> II LEGAL LOTNO. BLOCK TRACT � � <br /> ��, oFs� 4 ��� h��� F��� �►��h " � <br /> OWNER ADDRESS ` � qTY21P PHONE I <br /> I� �tL�ir�H�.-�R�t-�ir1 �►��1�-1r 4= r '�t3 �ro 't`'�y 2c� - ���4 . it�g2- , <br /> ��N��wa�U u1l4 `l��b"1 `� <br /> I TENA NAME � / CON7AC'�FORPEftM�1T PNON�� `^ � �I <br /> ,� � � �" <br /> C 1 C�.u:� (� � �Y (�Y�i�1`�.1-���1���'`,� � <br /> � GONTRACTOR .�}'�.p��4 ADDRES�—T(�- �r--� CITYIZIP PHONE I <br /> l T✓ 1� i�D-�.�d0.C: 'K2.��'� i.i✓�`���' � !, <br /> CONTR.LICENSE% /'���LG�" , �`' l.�Z�?5 �'�(OS Z . <br /> �a m <br /> �� USE OF BUILDINC�l HEAT SOURCE CONTRACT PRICE OF WORK I <br /> �JL1`-'1N l�'��� �Electric _Gas_Other �'�" ����'/ ��� I <br /> �I'�, WORK DESCRIPTION (' I" ZZ/�1"I V 1�i c � �- �a <br /> i �'r�h171�1� � �OQ``�' �, '�tr� o�- 1 PYIv <br /> C:GN���t�=C- '�u�,r-1c�. 1�ti�. NON ��TK��(�%� l. L('��'�o��Nt�'�� - <br /> i _ i <br /> IPLUMBING MECHANICAL I <br /> NO. 7YPE OP FIXTURE OR ITEM NO. TYPE vF FI%TURE OR IiEM � <br /> '� Toilet _ FVC-air handling units �� <br /> �'�, Bathtub _ Forced air systems <br /> � � Lavatory��r;h basin) _ Gas piping <br /> Shower _ Water heafer <br /> Kitchen sink&disposal _ Gas fireplace �. <br /> Dishwasher _ Gas range � <br /> � Ctothes washer _ Clothes dryer � <br /> �II _ Laundry tray = Range hood � <br /> Sink(servicelbar/mopletc.) Exhaust fan <br /> �, Backfiow preventer _ Heat pump ii <br /> ! Ur,nal _ Unit heater <br /> '� �nnking Fountain . _ Boiler ' . <br /> j Floor drain __ Refrigera,ion i <br /> I Grease trap __ Woodstove i <br /> �, _ Roof drains � _ Other <br /> Other — <br /> � CITV OF EVERETT LOCAL SALES 7AX GODE IS 5105 � <br /> �. I hereby ceritify that I have read antl examined this application and kr�ow the same to be tme and correct. AI�provisians of law5 and <br /> �'� ordinaces goveming this type of work will be complied with whether spec�fied herein or not The granting of a permit dces not presume I <br /> I� to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfomiance of �. <br /> '� construction. That I am authorized by the owner of this property to perform the work fbr which application is made and I comply wdh the �,, <br /> ' State Cpgtractors La 18 27 and 2962�0 WAC. I <br /> I � �- �1l"`.-� �'����\ � ' � �� II <br /> �i Signatufs OwnedContr ctor�Authorized Agent ���e ( .. <br /> /� I <br />