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_ _ - --------- --------� <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 <br /> i425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I�')G76� OS� <br /> SITE ADDRESS PARCEL TAX I.O.p PERMIT p <br /> 00..3 cn-�� . 0��0 /SOO 00 /D� - ' <br /> I LEGAL LOTNO. BLOCK TRACT i <br /> �ESC. <br /> OWNER ADDRESS CITYlZIP PHONE i <br /> � ,�a�-;�. 80o c�.� Q� � R.�..za�, GU� ; <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,�ae�,.ig., �' , . 5�0 _s� Q�.i�t�. .�7: 6�.�L�. �?a G o?�8-�7�� <br /> CONTRACTO ADORES CIT7 lZIP PHONE <br /> o1�e-Q,o,��_��.e..E.,� �w. S�Goo 5. /3s<� �...F ,.Ge-�c., u/iF -?ob-z�P-P��� <br /> CONTR.LICENSE ll <br /> f/oCFfDPT379�o <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> j � ��� ^� _Eleciric _Gas_ ✓Other 5� �DO, �O , <br /> �� ORK DESCRIPTION <br /> ��.��,.�� (�� �I �u, ��) �,���.� �-�- �--� �'� ,�� -","`�. � <br /> ' I <br /> i PLUMBING MECHANICAL � <br /> I NO. TYPE OF FIXTURE OR ITEM N0. TVPE OF FI%TURE OR ITEM i <br /> I _ Toilet / A/C-air handling urnls ! <br /> __ E3a�htub Forced air systems , <br /> �' _ Lavabry(wash basin) _ Gas piping <br /> Shower Water healer i <br /> � _ Kitchen sink 8 disposal _ Gas freplace � <br /> �� _ Dishwasher Gas renge I <br /> , _ Clothes washer Clolhes dryer <br /> �, _ Laundry tray Range hood I <br /> �. __ Smk (service/badmop/etc) � Exhausl fan i <br /> ��, Backflow preventer Heal pump <br /> �� Urinal Unit hea�er I <br /> � __ Dnnking Fountain Boiler I <br /> �, __ Floor drain _ Re(rigeration <br /> ' Greaselrap Woods�ove <br /> �, Roof drains Other <br /> j Other_ � AHu <br /> -- ---- — — i <br /> ; CITY OF EVERETT LOCAL SALES TAX CODE IS J105 I <br /> i <br /> � I hereby ceri6ly that I have iead and exammed lhis application and know Oie same�o he true and correcL All prowsions ol laws and � <br /> � ordmaces goveming Ihis type of work wdl be complied wdh whether specified herein or not. The granting of a pernut does nol presume <br /> I lo yrve auQionly lo wolate :r cancel the provision ol any o�her slate or local law regulating construclion or the performance of ' <br /> conslruchon. That I am au�horized by Ihe owner ol this property to perform ihe work lor which application is made and I comply wilh Ihe <br /> Stale Contiactors Law 18.27 RCW ai 296.200 WAC. <br /> �� �� � J.� 9���o � <br />� Signatu ol Ow d o raclodAuthonzed Agent ate �/ i <br /> L <br /> _ - -- _- ___ __--------------------------� <br />