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�`� � PERMIT APPLICATION <br /> � ClTY 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 <br /> SITE ADDRESS PARCEL TA7(I.D.p PERMIT K <br /> z5o3 c �a Ave ���� vos��`�s� zo �so � I :`���0ia . c� � l, <br /> I Lf.GAI LOTNO. BLOCK TRACTORSUBDIVISION• <br /> DFSC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> `J�1 '� 1 � w��2 �}.vti2 (,�5 5 �� <br /> TENANT NAME COMACT FOR PEHMR PNONE ��;�; �/�"��)4y-� <br /> �.JV� � '�-i�i,�rnl (.�/�hS�r�- e-Mav7ofwu+L:�/���tcG �cu40 {�i{.� <br /> I / LiTP G, <br /> i�t,'KS�I�n�Y�r� (,(,�A�,t; Y��n�'�"� /�SdC /C��ha,�, dJr'�b� /-1 t7�'�� <br /> CONTR.UCENSE�iLi A�N'LC X-`�$iJ 0 t� ; ''—.ac/Lc�.u. � �.�k� `/6'cJ 0 `� �76� `S'�`S� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ./1 . �r `�, ./.��--� '� ElecVir. ___Gas__ Olhcr —5io — <br /> y�(, n�y-t <br /> WORKDESCRIPTIONn�a� � /� \ �I G'J� � G L(�-f-/ �x�/L <br /> �,' � � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl%TURE OH ITEM NO. TYPE OF FIXNRE OH ITEM <br /> Toile� NC--air handling uni�s <br /> Dathtub Porced air systems <br /> . Lavarory(wash basin� Gas piping <br /> Shower Walcn c�alcr <br /> Kilchen sink 8 disposal Gas lirepince <br /> I Dishwasher Gasrange <br /> i ./ Clothes washcr Clolhes dryer <br /> Watm hcater Rangc hood <br /> Sirh(serviceibadmopictr. � E�haust fan <br /> . [3acktlow prevenlcr __ Heat pump <br /> Urinal Unit hCaier <br /> Drinking Fountain ,___ Boilcr <br /> Flaordrain ___ Refrigere�ion <br /> Grcasc Irap Woodslove <br /> Rool drains Other_____ <br /> I � � Othei —_ <br /> I — ------ _.__ _—� - ----- – --�----- <br /> dTV OF EVERETT LOCAL SALES TA%CODE IS J105 , <br /> I hereby cerilily ihat I have read nnd examined Ihis application and know the same to be ime and correcl. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied wilh whelher specilied herein oi not.The gran�ing ol a permil does no�presume <br /> I lo give aulhority to violate or cancel ihe pmvision ol any olher slale or local law regulating construclion or Ihe perlormance ol <br /> cons�mction.Thal I am aulhorired by Ihe owner ol this property to peAorm Ihe work for which application is made and I comply with ihe <br /> 5�ro` Contrnctors Law 1B.27 HCW and 29G200 WAC. <br /> � .RSs.�� 12-3-Cx <br /> Signalure of Hn /e,i 6on r o Authonmd Agent Date <br /> �� <br />