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� PtRMIT APPL.ICATION <br /> CI�Y OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVEP.ETT, WA 98201 <br /> 425-257-8810- F4X 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���3-�p_g.1,�, <br /> SITE ADDRESS PARCEL TAX I.D.!t P[RMIT tt <br /> �12 �- �'b�c���fwv� cvv3 'i3yzsv�� � �'L��o�/-/� <br /> LEGAI LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ( / CIN21P PMONE <br /> �V LL.4�.0 � F ti C Y-i�wy4,� l k...� I 1.L 1�I (7 ILr.LIC..�FL�(!-L /ita..� �L✓'...,�i�T� l.�.�i 2-U ) <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> f- iioP I �2.t�( t,�,�_.Z..i�-x 3�+V -7S 7- � Soq <br /> CONTRACTOR • ADDRESS /1 CITYIZIP PHONE <br /> Q� �-1 �r1tic �N.a�c.�l Illl Qo �-� 1����s..� f�ul�i, w,7 3�v �� 7-G5o`i <br /> C NT .LICENSC# <br /> � l�n1L`-Ll * �j���L <br /> USE OF BUILDING I HEAT SnURCE CONTRAC7 PRICE OF WORK <br /> Q�� � � _Eleclric __Gas_Other � �� I C'1 _ U �/ <br /> WORKDESCRIPTION (�N[��LCo �JUN � '�-'�"'�^` ��- I�^� �- �' ��IT��,l�ti- v''�" / <br /> -T� lv,� r � S,�i�t_._ �.;.`r��L hy Cil+ti.��.. , sNUL �nd�f.lU.lti�c. F r✓C ,u i �fy� <br /> � <br /> �.3) �t .�-¢..;t� wm�... ,, l3) rlen � �t��...a �i..._ S�-..L �3...� Id�a.y . 2�' /..i7-rt..� 'S.-�Ay �waRa 13u<1 iHs <br /> PLUMBING MECHANICAL <br /> NO. 1YPL OF FIXTURE OR ITEM NO. I TYPE OF FiXTURE OR 1�EM <br /> 3 Toilel FVC-air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas pi�iino <br /> Shower Water heater <br /> KitchPn sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Laundry t�ay _ Range hood <br /> Sink(sen�ice/bar/mop/etc.) _ Er.haust fan <br /> Backflow preventer __ Heat pump <br /> Urinal Unit heater <br /> Orinking Fountain Boiler <br /> I Floordrain _ Refrigeretion <br /> Greaso Irap Woodstove <br /> 3 Rooi drains � Other _ <br /> _� O�FICfJ��rl�.t. L (,.•.�s���. Iw..i.�IL Ii��E'. ��IS.;�.) _ _ '_ <br /> — ��LL11t.f."tit.-� — <br /> CITY OF EVERETT LOGAL SALES TAX CODE IS 3705 <br /> I hereby ce�itily ihal I hav�road and examined fhis application and know lhe same to be true and correcl AII provisions of laws anA <br /> ordinar_es yuvzrning this lype of work wi�l be comptie�!with wheth�r specified herein or noL The grznting of a permit does not presvme <br /> to yive authority to violate or�ancel the provisior ot any olhar state or local law regulatiig construction ur the periormance of <br /> constru Lon. fhat I zn aulhorized by the ownnr ot th�s propeity to perform fhe work tor which appliwtien ia made and I comply with the <br /> State ntradors Law 18.27 RCW and 296.2110 VVAC. — <br /> ��� �1 t9- o <br /> Signature of OwnedContractodAuthoized Ngo�t Date <br />