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' P`cRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8. CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PF�RMIT# <br /> Z� Z `l ��..�� S�.-� do�/3� �67 0 0 ��S- � / <br /> LEGAL LOTNO. �LOCK TRACT I <br /> DE50. 8 -9 - I U � Lv . �J ' • <br /> OWNER ADDRESS CITY2IP P�i NE <br /> �Ls?��I- (,6L�- <br /> � ' 7- D�.ut.lur°���-��- CU• �/D�ZC�Iby �9✓�- si� l�3 �„4-�a-f-wN qBLol <br /> TENANTNAME � / CONTACTFOR PERMIT PHONE <br /> I .�� .- ���,,•� �i <br /> �,_��k l��c.�.�,y �l� >>� ��� � � �/z-,S- Z3 `I- Z2.9 $ <br /> CONTRACTOR �/ ADDRESS qTY21P PHONE <br /> _.-.!\ <br /> CONTR.LICENSE# �., <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /� ,{� % J � �j �,�� <br /> /7�{afJU��y 1\t�c��� SG.J/� Electrir, X Gas Other <br /> WORKDESCRIPTION .-r� �wS���� /1�;� (��u{-�-. .1 L3 �X /� � ,i �J � �,. SG,,��J <br /> � U /" <br /> L'J�.�-l� �,r�,'. S� �J,-rs.fi��J ,.`i-�s+1_�-I <br /> PLUMBiNG NlECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _I Toilet A/C-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br />' Shower Water heater <br /> _ Kitchen sink& disaosal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Ctothes wasner Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service;bar/mop/etc.) Exhaust fan <br /> _ Backflow pre�enter Hoat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Re(rigeretion <br /> _ Grease trap Woodstove n <br /> _ Roofdrains �_ Other /�i �V.-f- /��,��f� <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> . I hereby ceritity that I have read and esamined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ; ordinaces•�o�erning this rype of�.vork�.viil be complied with whether specified herein or not The granting of a permit does not presuma <br /> ito give authonty ro violate or car.cel the provision of any other state or iocal law regulating construction or the peAormance of <br /> construction. That I am authorized by the owner of this property to perform the wark for which application is made and I comply wilh the <br /> � State Contractor�Law 18.27 RCW o...00 WAC. <br /> ' /���� .S- /9' �S <br /> Signature of ONnenCo irac:onAut7onzed Agent Date � <br /> ; a <br />