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�� � <br /> �PERMIT aPP�ICATION <br /> CITY OF EVERETf PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257•8810— FAX 425-257-8857—www.everettwa.org <br /> APPI.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.q ERMIT N <br /> I`�3c% "L���W�e�� �i�/F O OG-'1:��-I 2�`0�o I"1 o I ��)����. � �:.`� <br /> LEGA LOT NO. iB�LOCK TRACT OR SUBDIVISION p <br /> DESC. �1- ?_o I � L i-�`� '�a1J J� _ <br /> OWNER AO�RESS CITV/ZIP PHONE <br /> GC?�'�mu�it� Hch�t�t c�aSOFSi.x����o ��,`�f'.�x� G�'trL� c��r_�r� <br /> TENANi NAh1E CO�JTACT OR PF.RMIT PHONE l(2j- Z"p�(-3"��' <br /> `.��� �\ Fif1a1-L?t��P+�1Zr,�41{-�( I�.��{a(,ZLf`CS E'f1���r E•MAIL <br /> � T�J{Z A(jf;A[( C1�1-�5'i"- DD 5 CI / I <br /> �v .i?�,�1�- S�(v�(�' ac�tctc��=�- �CSI3/ <br /> CONTR.LICENSE# _��� .���GI��Z�� C_. ?��, -y�,Z-�� <br /> r.� <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> m���.�./�.':' t����� �-���--`' _Electric _ _Gas__Other 33���+�� <br /> WORK�ESCRIPTION <br /> �IJ`JT�'k1.-1, "$LIILC�'� I'��>l�3'7i�T HLtaSS (-'Pv2Zl,TtCJ1J`J t'f LA/lall� (��LS <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FlXTURE OR ITEM N0. TYPE OF FIXTURE OH ITEM <br /> Toilel _ NC-airhandlingunits <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas(ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cbthes dryer <br /> Water healer Range hood <br /> Sink(servicePoar/mop/e�c.) _ Exhaust fan <br /> Back9ow prevenler Hcat pump <br /> Urinal Unil heatcr <br /> I = Drinking Fountain = Boiler <br /> Floor drain Refrigeration <br /> Grease Irap VJoodstove <br /> Rooi drains Other <br /> Other <br /> CIN OF EVERE7T LOCAL SALES TAX CO�E IS 31D5 <br /> I hemby ceritify that I have read 3nd examined this application and know Ihe same ro be true and wrrecL All provisions of laws and <br /> ordinaces goveming ihis type of work will he complied with whether specified herein or nol The granling ol a permit does noi presume <br /> lo give aulhority to violate or cancel the provision of any other slate or local la�v regulaling construction or the pedormance o( <br /> consiruction.That I am authorized by ihe owner of this property to pedorm the work lor which epplication is macA and I comply with ihe <br /> Stale Contraclors Law 1827 RCW 296.200 WAC. <br /> C-U '' � A` � R., c <br /> SignaWre of Owner/Cont actor/Au�horized Ag � e <br /> �I� <br />