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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - �EBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD ESS PARCEL TAX I.D.ff PERMIT# <br /> Ibo a wu, tve.�e#I�w a��� c�ou� 3sa b oa oo So(� -� <br /> LEGAL LOTNO. ULOCK TRACT {� <br /> DESC. �'� -OO L-'rerd�' U�' N. �� <br /> OWNER ADDRESS 5��� �3OU1 IZIP PHONE <br /> �-Gt,lise, �IGtC�+�-iNl 2C01 bf� AveLSe�.}He ►✓Aq8«� �6-`t4-��lu)N <br /> TENANT NAME COyI.ACT FOR P-RMIT PHONE <br /> �.r �_� �,�/�iL.�fi'i�` ��lw� ��-rJ-��� 5�3�/D - `/�7.�2 <br /> �„�`— l <br /> CONTRACTOR�fj• CQtµV PlUnbf ADORESS � CITY2IP PHONE <br /> pluM�si„�Lf�.�E 6 al H?�93c7'�- I o8�s S�. 2�ra.!�nve 5o3-t�s$ -n� 3 <br /> CONTR.LICENSE#��/��017^o13/+ j1 �e6�'Yart ��t q7�� so3�14-73ly- <br /> �-L l l..(J <br /> USE OF BUILDING I — HEAT SOURCE CO RA�OF WORK <br /> ElecMc Gas Other <br /> O� <br /> i <br /> . <br /> WORN DESCRIPTION <br /> � <br /> J�����'Q��1bS <br /> PLUMBING � �(�i, ' � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITE U� NO. TYPE OF FIXTURE OR ITEM <br /> r <br /> Toilet G\ A/C-air handling units <br /> '� Balhtub ��G Forcedairsystems �-� � . <br /> � Lavatory(wash basin) �� � Gas piping , <br /> _ Shower '� � � Waler heater � <br /> Kitchen sink 8 disposal � Gas fireplace i� <br /> Dishwasher Gas ranc�e <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan ^y' <br /> — ^ / <br /> _ Backflow prevenler Heal pump � :�{-�1� /r <br /> Urinal Unil heater � <br /> Drinking Fountain Boiler <br /> '� Floor drain _ Refrigeralion <br /> Gmase trap Woodstove <br /> Roof drains Olher <br /> — Olher �� <br /> L� y ;�_> = la'"� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby cerilify that I have read and examined this application and know the same to bo tnn:and correct. All provisions of laws and <br /> ordinaces governing this type of work will 6e complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> to give authority to viola�e or cancel ihe provision of any other state or lowl law regulating construclion or the peAormance of <br /> consiruction.That I am aulhorized by the owner oi this pmperty to peAorm the work for which apolicalion is made and I comply vnlh the <br /> State CA�+lyactors �w 18�27 CW a d 296.200 WAC. / <br /> / � <br /> � Q /y� - � - dS� <br /> Signatu�e on� ctodAu honzed Agent � ate --� <br />