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( � <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 G ��� „ p� <br /> SITE ADDRESS � PARCEL TA%I.D.N PERMIT N <br /> �ic�3 �� 'as ���o R l 7��D� `Is 3a1 1$ C�I IuUU 1(7c� 'LJ� I XL�C�-(v' S <br /> .c ,,.� 5 Z i �— <br /> LEGAL LOT NO. BLOCK TRACT <br /> oesc ; c � c� 'i wv zb 4c�c uy C I/L Scc Ev c C i+r�� o <br /> c� . E xc ,.� k� a-� s-t �F wA Pee v--n <br /> OWNER . ADDRES� � CITVZP PNONE <br /> �rv- 6�e i,� ,,.. a„ Fv�.��}t- wq / <br /> 5 � P �-t M° g{'o oou � �g'Z� s N �- <br /> TENANT NAME �� ��(.� � CONTACT FOR PERMIT PHONE <br /> �oei�� - �ve�ef� yS- .3��� �- iiS Sv�.ar�Sp��. �]_u�) `IOl - 2kZ� <br /> CONTRACTOR ' ADDRESS CITY2IP PNONE <br /> i11c��1�c�,•c:lJ �l���I�Lr -7-111 �1ru ��" �.�. SW`- �j(� (k�OG- �-1b� 'U)-7'�f <br /> CONTR.LICENSE N Jc�11�' �X�V�. <br /> �,nA�oJFs 5ao 2� � z.- 3 i - �b <br /> U',SE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> \ �•��1✓L^�-�` � •_1 I U�� ( '� �[,Eleclric _Ges_Other � / �� �70�. po <br /> WORK DESCRIPTION ? <br /> b'LC�.�. : Add ,1 FiV�c�.�� t ��..�5, c� c��� 1 Spl �f- S.�SY����, ��c•.i' dv.n^�� .�cl �} W�Y r �Fd <br /> .�ddC�,.ks �dc Lo� .;e} �� �i� oc rofc� r �p �ny c-�.�. �1���-w�,,, k � D,FF,,,,,c• �C�i��l.¢9 . <br /> 1�L1'NB �. i�c`c\ '� ��c.i �.C15 S ,..n�i��5 S �t.11.it�•� i ...1,5 1 Q �c(t W ��'1.v LdV�C.�� � EyE L+i��o <br /> S�fr1"lo.., ( v��l\ F�.��n.,� � �unv.� (�vt.in 1 (�o,� Sri1k tinT Mlyt � i��_i ' <br /> PLUMBING MECHANICAI " <br /> NO. TYPE OF FIXTUN[OR I1EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC–eir hendling unils <br /> Bathtub Forced air syslems <br /> � Lavalory(wash basin) Ges piping <br /> Shower � Water hoater <br /> Kitchen sink 8 disposal Gas Greplace <br /> Dishwasher Ges range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> � Sink(service/barlmoplelc J ,� Exhaust lan <br /> DackOow prevenler � Heat pump <br />� � Urinal _ Unil healer <br /> Drinking Fountain _ Boiler <br /> F loor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> 1 Roof drains 1 Other <br /> _3_ Olhercya..._A �'• 1.p��or — <br /> -- i.��L�f��a.. iu�l.{i i — <br /> CITY OF EYERETT LOCAL SALES TA%CODE IS 7705 <br /> I hereby cerilily ihat I have read and examined Ihis appliwlion and know Ihe same to be Irue end corroct. All provisions of lews and <br /> ordinaces governing this type of work will be complied with whether specified herain or not.The granting ol a permit does not presuma <br /> to givn aulhority tu violate or cancel Ihe provision ol eny other state or local law�egulating construction or the perloimance ot <br /> conslruction.Thal I am authorized by the owner ol lhis property lo peAorm the work lor which applicalion is mada and I comply wilh the <br /> �S1McGonUaFlo��n,^v W a�M� 200 WAC. — _ ^� <br /> l: <br /> wner/ ontractod�ut o n! ate <br />