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'i �� ,>-� <br /> .�— ----- — --- — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-wuvw.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -Z ,. �/ -p 7 <br /> SITE ADDRESS PARCEL TA%I.D.# I� <br /> PERMIT iF <br /> oz �' I Y�zo� c. �y3�'c3 �o3�oa _ ,z -ci�; � <br /> lEG LOTNO. BLOCK TRACT I <br /> DESC' <br /> OWNER ADDRESS ,,Jrz�,� CITYlLP PHONE I <br /> _ .�;� �,v��s iX,� �.�6�� ��- ��-�� � ,�- y�3�s �✓;,� <br /> TENANiNAME I CONTACTFORPERMIT PHONE � <br /> /VI�' ��i..� nn lt/CGsr�:z- 71G�� 978'-ft5��{ <br /> CONTRACTOR • ' l Ji CRY�p PHONE <br /> �URS NiNi��lrl ��.�T&/� ADDRE s j>5�.� ! /^fi�e`G �c-'�n - <br /> CONTR.LICENSEA �"��Ly � <br /> ^ �<�µ ,��'/Ll %� s� }7`� �� <br /> �!/fh/y'.ItJt"��.C1(J� �J�'?,:3�� <br /> USE OF BUILDING I HEAT SOURCE I CON7RACT PRICE OF WORK <br /> _Electric Gas Other �t{� ` <br /> WORK DESCRIPTION /" � ,,/ <br /> G'�u-;;� �� C ,) ��-5 Gl�""" �,..�'��i"L <br /> PLUMBING MECHAN(CAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR I7EM <br /> _ Toilet A/C-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower � Waler heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas renge <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br />. _ Sink(servicelbadmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Fioor drain Refrigeration <br /> _ Grease Irap Woodstove <br /> _ Roof drains Other <br />' Other — <br /> CITY OF EVCRETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerdify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and I� <br /> ordinaces goveming this type o(work will be complied with whether specified herein or not. The granting of a permit does not presume � <br /> lo give authonty to violate or cancel the provision o1 any other state or iocal law reguiating construction or the pertormance of <br /> construction.That 1 am authorized by the owner ot lhis property to perform the work for which application is made and I comply with the <br /> Slate ConUadors Law 18.27 RCW and 296.200 WAC. <br /> ��=:�!n..._ w"_" '�"'�- ��--'� -J-� <br /> Signature o er/Conirect A onze�Agent� pe�� r <br /> �._— <br />