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. <br /> PE'KMIT APPL.ICATIOIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wv�va.everettwa.org <br /> APPLICATfONS ARE ACCEPTED FROM 8 AM TO 4 PM -� � 16 _O6 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1321 Col � c�p �138,s.�y6 oe0000 - ��/�i <br /> LEGA LOTNO. BLOCN TRACT � / � / <br /> DESC. LC4� S EE ��"�CI,.Nes�7 <br /> OWNER ADDRESS CITY2IF PHONE <br /> cf LS"- <br /> {Jro���(�,nC� Nos� �-{u,P 13� I Co I �y �ve. �ve,�e� �i 8'021 zs�-�z <br /> TENANT NAME —� CONTACT FOR P MIT !';,.a�n�_�� _ PHONE <br /> LYi l <br /> Unices4re�u� PCS�C Co�e,�. � ,hr�avn5 20(� � 3 `� q-y2'-15 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> 5f-(y C�NSUI�ingIGG (Z2p� _ NL~' p�id! 1 q�/ <br /> CONTR.LICENSEMS� CO��� �II�� �n. KI�IC1rj ]O� ���' /v6 ' ���07 <br /> K J <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I–� ,�, f��.�-� _Electric _Gas_Olhcr �3 S� �� <br /> I� <br /> WORK DESCRIPTION _�/ <br /> GU=F-a���cn�c s I/1 s�,rcods' �.� /'c,�w F, ,�'4.�'a �d�i.n G7S CT/r'{�j�it <br /> d`''�`�'��� S�u C��/(� <br /> PLUMBING NIECHANICAL <br /> NO. TYPE OF FI%T�RE OR ITEM NO. TYPE OF FIXTI'RE OR ITEM <br /> Toilel A/C–air handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater healer <br /> Kilchen sink&disposal Gas fireplaco <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> Bar.kflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ VYoodstove <br /> Roof drains Olher <br /> Other <br /> � <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify that I have read and examined this application and know Ihe same to be true and correcL All provisions o(laws and <br /> ordinaces govecnttg this type of work will bo complied with whelher specified herein or nol.The yranting of a permit dces nol presume <br /> to give aulhotiiy tq violale or cai7p�J Ihe provision ot any oiher stale or local law rec�ulating construction or the performance of <br /> conslrucyon.Tlial I am au�hoppp�edby lhe ow r o(this properly to perform lhe wo�k for which application is made and I comply with the <br /> Stale CohtFact rs Law 18.?�7RL`VJ and 2 200 WAC. <br /> / <br /> � ;j ���/^ � �Oc�G� / <br /> Signature of 0 / fltra odAulho zed genl Date �� ' <br /> �i \ <br />