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� P�RMIT APPLICATIr.1N <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 S AM TO 4 PM <br /> SITE ADDRESS PARCEl.TAX I.D.M PER IT k <br /> '�WJ'F`1' '7 -' �1 �: ,., t . J -0 <br /> LEGA LOT NO. BLOCK ' TRACT OR SUBDIVI910N N <br /> DESC <br /> OWNER ADDRESS CITYI2IP PHONE <br /> C.v:,:.�1,�j.acco �Ic:l. ��. � \� IS1 �31 ��)(a L'l�. C�l��« L�f������(.t V��lc�� �113(e .Z <br /> TENANT NAME I CONTACT FOR PERMIT PHONE (�a`� '��-1 b,•- I ����Z <br /> L�BATR�A6_> ���/i:� L'{- 4- ��._�• �,�V/"v�P..l�-- �,� E•MAIL J S-c:�J1Y��t� iF'F= C Ci�t,J'dt <br /> .c,,ry <br /> CONTR.LICENSE N <br /> z8� <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> t-�E c_f� �< � >�,I. �Electric _Ges_Other <br /> WORK DESCRIPTION <br /> �T��1�� �X� �o�.� 1S � ��_ .11�_ L'.S._ C>~ IY.��c .��S OVi�� d �l '{-e.�� <br /> ��a� Iti��.S , .�1\ ti��• �. ...a� \�? G�1 N�l � : l- � !. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> To@el PJC -air handling uNts <br /> � Batlitub Forced air sys�ems <br />, Lavatory (wash basin) Gas piping <br />� Shower Water heater <br /> Kitchen smk 8 disposal Gas fueplace <br /> Dishwasher Ges range <br /> Clolhes washer . Clolhes dryer <br /> Wa�er heater Renge hood <br /> Smk (serv�ce/bar/moplelc ) Exhaust lan <br /> �ack0ow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinkmg Pounlain Boiler <br /> Floor drain Retrigeration <br /> _ Grease Irap Woodstove� <br /> _ Rool drains � Other - � ���� <br /> Other <br /> CITY OF EVERETT LOCAL SALE9 TAJ(CODE IS J106 <br /> I hereby certity Ihat I have read and exammed Ihis application and know the same to be Irue and wrrect. All provisions o�laws end <br /> ordinances governing Ihis type of work will be complied with whether specifed herein or not. The granting ol a permit doea�ot presume <br /> to give authonty to violate or cencel Ihe provision of any oV:.er slate or local law regulating consiruction or the peAormance o( <br /> construclion Thal I am authurized by the owner of Ihis property to peAorm the work br which epplicatio� is made end 1 comply with Itre <br /> Stale Conlraclors Law 1827 RCW end 296 200 WAC <br /> . � �---�� � / — � � C, ��l • <br /> Signakire o�wnedCuniMclor/Au�hor¢ed ge� a�e � <br /> �__"- �. <br />