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, - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT N �, <br /> J ��4. �i4✓:?U.�lJj1 �' I�✓= M1.'✓c �.)•'�d : J;'�::Jl,(il.�l./ �� GI � W <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIP.'IZIP -�iioi.�/J�(. <br /> CV��'.6TT ��!'TE„�n1� (_�tn�r�rr_ LL�? ��r''�'�.K�'r-r�c�n_ 1�i'.: �Vci�cYt� i.J/� ;1O�Di-JSJ3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �rtJ" F �O!'JC �/K�I/na:6'I=/N� �G,J •' �' '�' �/ G S <br /> CONTRACTOR ���,N.., FL,J�- ADDRESS CINIZIP PHONE <br /> � i:I)v J Ct�'E>i 3' F:rtr.lM;.11�N,wA .��o�i- /,. lI— :/( � <br /> CONTR.LICENSE ft �` '�� <br /> ��r r�_'i i�?r,t�w <br /> � <br /> I)�E OF BUILDING I HEAT SOURCE ����j I CONTRACT PRICE OF WORK <br /> T r, c �' <br /> K�-.���_ _Elednc _Gas_Other "���- — <br /> WORK DESCRIPTION <br /> 1 /✓�//.�/_C.. JP�c �i � 1L.i..U��/PJA%_Y� ('/J.CNNEL LC�C/% $/G/V . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavarory(wash basin) _ Gas pipmg <br /> Shower Water heater <br /> Kitchen sink 8 Gisposal _ Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> Backflowpreventer _ Heatpump <br /> Urinal Unii heater <br /> Drinking Fountain Boiier <br /> Floor draln Refngeretion <br /> Grease irap _ Woodstove <br /> Roof dreins Other <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS J705 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and correct Ali provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision�of any other state or local law regulating construction or the performance o` <br /> construction.That I am authorized by the owner o(this property to pedorm the work for which application is made and I comply with the <br /> State Conir�ors Law 1027 RCW and 296.20�WAC. <br /> �.- '�_. �>�/di <br /> _ - J-� ----- <br /> Signature of Owne�r�'ontrector uthonzetl Agent Date / <br /> (z <br />