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f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-6810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Lr �/ Z�D b <br /> SITE ADDRESS PARCEL TAl(I.D.# PERMIT <br /> -;.��i_2 i=�rcn�i �a A� c_ cc. -� ; � ; : � z ��c l �C �-� �-c��' l <br /> LEGAL LOTNO. BLOCK TRACT ,.y <br /> DESC. ,�'7'.�)�. 'V� �Y�� J�: I lA: �'� �21�C �;�� �-��� �'� � �� L' � ��Q 1 <br /> OWNER ADDRE53 �' � CITYILP PMONE <br /> I�1� �liti�-it1�r�lit(� `k 1 �Ll� N1.�11�� `;h'ec1 �l.ihll�'r'� \L�11 " 3P,tt�� i — <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l �_� � � � �'acka� e; <br /> I L= 1i�cL Surcb� ..��>>,. �� 3 -� y �� l• <br /> CONTRACTOR AD�RE33 CIiY21P PHONE <br /> /\�1�c � 1( Ct�i NQC11 ��1C. `�1C: �31111��t C-1 ��� LGkt� ��ci_cl `�,�`� .�'�� <br /> CONTR.LICENSER � -J��'- �C=� ( 1UL�� !i <br /> I\� ILP �t��cU2nY� �_k� � ��.�, f�;� <br /> USE OF BUILDING HEAT SOURCE 1 ¢ONTRACT PRIOE OF WORK <br /> �'�t � L� l � Electric _Gas_Other 9i "�.' 1 1_;u . j• �-� .�� — <br /> WORKDESCRlPTION t�n�YZ �X1�� 11\f� SIC�f15 . L1S1n11 '1i1�1'��� �110.� 11���� '�'10.��U <br /> 1 <br /> �\���r�t���rt-�td� C ���C�;���E1 It11�5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF fIXTURE OR ITEM <br /> Toilet NC—air handling units <br /> BathWb , Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Renge hood <br /> Sink(servirnJbar/mopletc.) Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL 8ALE9 TAX CODE IS 3106 <br /> 1 hereby centify lhat I have read and examined lhis applicalion and know the same lo be true and corred. Ail provisions of laws and <br /> ordineces goveming ihis type ot work will be complied with whether speafied herein or not.The granting of e permit dces nat presume <br /> to give authonry to violate or cancel the provision oi any other state or local law reguiating construCion or the pertartnance of <br /> construdion.Thal I am authorized by the owner of this property to perfortn lhe wortc for which application is made and 1 comply with the <br /> State Contractors Caw 1827 RCW and 2963200 WAC. <br /> - i <br /> `�'' r <br /> Signatureo Ownerl ontradorAUth nzedAgent ate <br /> 1 � <br /> �� <br />