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- -- — � S 3.Z"`° <br /> PERMIT APPLICATION ,��-�-� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 �.� -�J� <br /> SITE ADDRESS / PARCEL TAl(I.D.# PERMIT q <br /> JG'1n l:ii�'�<ti� c✓ „'�� "'� pon4 7�lGC�i � C; c.� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. •'v <br /> OWNER �' , �a67. �'L x-ADURESS L-�,pcp CITYIZIP PHONE <br /> � - C(/ °j�'1 o7J �/z if-3�7- l G 7Ci <br /> ! / � S �.�,,� „1�� J,�� .�--��;-�2 /� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> /�. v��i'� �����P ��� � ��2i "i� 7� JL 7C) <br /> CONTRACTOR 7� 1 ' L, i�� ADDRESS CITYIZIP PHONE �, Gq <br /> ��<n b�4J !f1 � n U s <br /> // r'" <br /> 7�•C� �/�//I/1ncNL/rrt �}� Gr� / 2 -�/ 1 ' / !Q� <br /> CONTR.LICENSE M � 1 � <br /> /�i5 vx.��t 9Y� S 7 _ <br /> USE OF BUILDING HEAT SOUR�E CONTRACT PRICE OF WORK <br /> i � ,� _Electric �Gas_Olher �c�/7���� <br /> NORKDESCHIPTION /,�� , �i , .., ,� / ",�, ., L -�il;r.r��� � — n 'r=< /�;Ji-,C" •� f/iC/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF fl%TURE OR ITEM NO. TYPE OF FI�TURE OR ITEM <br /> Toilo! A/C-air hand�ing unils <br /> 1 B�thtub ,� Forced air sysloms <br /> / Lavalory(wash basin) �% Gas pipiny <br /> Shower Waler hoa�er <br /> Kitchen sink 8 di���osal _ Gas fireplace <br /> Dishwasher _ Gas rang� <br /> Clothes washer CWthes drynr <br /> Waler hoater -� Ran�e hood <br /> Sink(scrvicdbar/mop/ota) Exhausl tan <br /> �acl.flow proventer _ Hoal pump <br /> Urinal Unit hoator <br /> Drinkin[� Fountain _ Boilor <br /> Flcor drain Refrigera�ion <br /> Greaso Irap _ Woodstove <br /> Rool drains Othor _ <br /> Olher <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritily ihal I have read and ezamined Uiis applicalion and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces governing ihis type of worA wi7 be complied with whether speci(ied herein or not.The granting of a permil does nol presume <br /> to�iv�authority to•iiolalo or cancel Iho provision of anv�tlicr state or Iocal law regulating conslruclion or Iho peAortnance of <br /> construr,lion. That I am aulhorized by the ownor ot this property to peAorm Ihe work lor which applicalion is made and I comply with the <br /> Slale Contractors Lan• 18.27 RCW and 236200 WAC. � <br /> , � r�, , <br /> j � ' . r�� � I /M,I: �.q.�. � nN <br /> � ,- ;�. 'r�. r�. <br /> Sic�nature of Owner oniractor/Aulhorized Agenl Date <br /> �z <br />