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� PERMIT APPLICATIOi� <br /> CITY OF EVERETT PERMIT SER�'ICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 �- �b --0,6 <br /> 425-257-8810- FAX 425-257-8857- ww�v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � `�Lr�'� `�! <br /> SITE ADDRESS PARCEL TNi I.D.p FERMIT p <br /> 7U/y - C�.:Q ��p C�.,r.tt L„tx1 �4 ��.3�r3sppm�aa m�a ��L"U'�/ ��� _ <br /> LEGAL LOT N0. BLOCK � TRACT� ��/)2_ �7 /1 <br /> DESC. � V �'��" 3 � C v-L/�� <br /> OWNER AO�SS CITY2IP PHONE <br /> L��X/�si-�re Cw,<�,.��-�., �,� d�� ��i ��•lkll YBnf,� y,�s=�y�v9�s <br /> TENANTNAME CON7ACTFORPERMIT PHONE <br /> . . . � ��., � f-lQ�>�s� �.; � 'y,�s�-yys�-y9�'s- <br /> CONTRAC70R ��,�` �� L '���n r�. AD:RESS CITYfZIP ' PHONE <br /> !� 4- � <br /> . i <br /> CONiR. LICENSE 0 � � � � • � <br /> E/i�-�E<z r� 7 �K % ,l,'' - 7 — <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� _Eledric �Gas____Olher � <br /> WORK DESCRIPTION <br /> 5/'t� �l>k; L�„�s�i��.c,''�o�__ <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. fYPE OF FIXTURE OR ITEM <br /> 3 Toilet / NC-air hanAling units <br /> J7 DalhWl%L, Forcod air syslems ✓ <br /> y Lavalo wash basin)� �_ Gas piping - <br /> �� Show rr" Waten c�ater�� <br /> _�_ Kilchen sink 8 disposal ✓ � G2s lireplace.- <br /> J_ Dishwashcr✓ � Gas ra�c�e� <br /> / Clolhos washer✓ _L Clolhes dryer� <br /> 1_ Walerfwatcr✓ 1_ Rangehood,� <br /> -- Sink(servico/barlmop;etc.) ✓ � Ezhausl(an!v;; <br /> �_ Backflow preventer✓ _= Heat pump ' <br /> — Urinal = Unil healor <br /> .— Drinking Fountain = Boiler <br /> — Floordrain Refric�oralion <br /> —� Groas� trap = Woodstooe <br /> _j_ Rooldrains =_ Olher__ <br /> — Olher <br /> — CITV OF EVEREIT LOCAL SALES TAX COUE IS�105 _ I <br /> I her�by cerilily Ihat I have read and ezamined this applicntion and know Ihe same lo bo Irue and corrocL All provisions o(laws and <br /> ordinacbs yoverning this type ol work will bo complied wilh whulher spocilied heroin or nol.Tho granting ol a permil does nol presume <br /> lo yive authority lo violate o�cancel lha provision of any olher slalo or local law regulating consWclion or tha periormance of <br /> � conalruction.Thal I am aulhorized by Iho uwnar of lhis property lo per�onn the work for which applicalion is made and I comply wilh tho <br /> ISta}e'Conlrar,( 1(i. 7 RCIY�ud 296,200 WAC. <br /> / -. i <br /> ; , . ,� � ��.-�� <br /> � S ure of O nor/Con ctorlAulhorized Agert � Date � <br /> I .. . .. . . . . . . _ _. /Z <br /> ,' %.=� ��_. J � <br /> . . <br /> ,� , <br /> ,. � ; ,5 ._�-- <br /> ___--- - - -- - _ --- -- �- <br />