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� P�RMIT APPLI�CATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WF� 98201 <br /> 42i-257-8810- FAX 425-257-8857-www.everetbNa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO t PM <br /> SITEADDRESS ��',"� �'�t!` i" '����'ro; s��� '� pqRCELTAXI.D.# P�,RMITp <br /> / t,� <br /> �� � � ��. .�� � fSuVJ �� �G)� - �GL <br /> LEGAL LOT.VO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITYlZIP PHONE <br /> li��'C lb'�7 <br /> TENANT NAMt CONTACT FOR PERMIT PHONE <br /> t�:� � ,,,, r� Y��r�� /[��SNiHrorv 9Z5 9i� i��iz <br /> CONTRqCTOR . ADDRESS CITY2IP PHONE <br /> �„h �/ M1ii,.�irv.' r,�i.��t�u�;i�n, r�.i�✓in''/ <br /> �iils �Cn�.4�t s_r,ni .k97nt, {�.q > – <br /> CONTR.LICENSE p ��G'- �U< - J/I) <br /> �i.lr�y�'IfC l;� �p�1i�' 1 . 1 `�- I�`'� �Jk'/i- k� <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> '���' i ( l�-1 4r-�l IA1 'li (� 41ZI�R'Rr_ <br /> Eloctric Gas Olher �� ��, '�`�� <br /> WORK DESCRIATION , � ���cx t�/�T n'��v�' <br /> �'G i l�il)t ��( 11�. �.' (�i/i'CF'( If l� l�l r=i �.i) SC� ' ;A'ucG 1 (��( 1�� �`-' �6�r/S�N ) i'� � <br /> � � <br /> ( /iiN!/A�h ,IA.�i S//( 1) ("aA .'�I'/, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> loilc� A/C–air handling uni�s <br /> Bathlub Forced air systnms <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler hPaler <br /> Kilchen sink 8 disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> _ Clothos washer Clolhos dryer <br /> Water heater Range hood <br /> Sink(service/badmop/olc.) Fxhausl lan <br /> Backllow prevenler Hea�pump <br /> Urinal Unit hoater <br /> Drinkinc� Founlain Boiler <br /> _ Floor drain Rafrigeration <br /> _ Gre2se Irap Woodstova <br /> Roof droins Other <br /> Othcr <br /> CITY OF EVERETT LOCAI SALES TA7(CODE IS 3105 <br /> I hereby cerili�y Ihat I have ro�d and examined this applicatlon and know the same to 6e irue and wrrecL All provisions of laws and <br /> ordinaces yovo�iing ihis t�pe ol work will bo complied with whether spctcilied he�ein or not. The granlinn of a permi�does not presumo <br /> Ilo givr, aulhorit�, to violatc or cancel Oie provision ol any other slate or local law regulahng consiruction or the peRormance of <br /> consiruction. Thal I am aulhorized 6y the owner o1�his property to perform the work(or which applicalion is made and I comply with the <br /> � Slate ConlraGors Law 18.27 RCW and 296.200 WAC. <br /> � 1i. <br /> C< < � ��(����j� iJii �i� � L�Iti' � S � <br /> Sigri�Wre of OwnodConlraclorlAuthonzed A�enl Dale .. <br /> I _. . . ------- ----------- -- -- - <br />