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a— � -o� <br /> PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERWICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657 —www.everettwa.org <br /> APPLICI\TIONS ARE ACCEPTED FROM 8 AM TO 4 FM <br /> SITE ADQRESS PARCEL TAX I.D.# PERMIT 1i r, % <br /> �722 LG��3 �r{/d(I G� 00 �9 ��oZ�el DO �l%D! � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � 2� 2 D� <br /> OWNER ADORESS CITY2IP PHONE <br /> ���1 UlJa�l, �325 �-�' �, s7� r��s��jl�,cclA qBlb1 <br /> TENl1NT NA E CONTACT FOR PERMIT PHONE <br /> �r�e�r �+�cr �°�. "`�+`� �b��.�a�l <br /> �b+For�►Sl� �1'�/ � fi��8 ��� `�'1�. '��}1.3161 <br /> CONTRACTOR AODRESS CITY2IP PHONE <br /> CONTR.LICENSE# �� � �— �" „ "�•_`"� <br /> USE OF BUIIDING I — HEAT SOURCE .�-�- I �NTRACT PRICE OF WORK <br /> � 'I � vo <br /> pl N�O Electric _Gas�Othe�V P `Q7� (,i�"� '� <br /> WORKDESCRIPTION �K�y �� W�`� �RS R���' <br /> (�U�i-(�21�T'b�p��N� u.1Ft{.L�6` TCQ�G�TlOn► �O� 'E'J�-(�1�1(� (J1��1�Y�1 <br /> L� -},V�ADD NEk1 Pa►s�- 4Jk'TA �P P�� cxl'C�� - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. �1'PE OF FIXTURE OR ITEM <br /> 1 Toilel A/C-airhandlingunits <br /> Bathtub Forced air systems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal Gas freplaco �p�l WJAI. ��rr Ytll� <br /> _ Dishwasher _ Gasrange ��� � ���P,� <br /> Clothes washer _ Clothes drye <br /> Laundry tray _ Range hood '�i�j� �� ���-�'� <br /> Sink(servicelbadmop/etc.) Exhaust(an .b���� (�0�' <br /> BackOow preventer T Heatpump � <br /> Urinal Unit heater <br /> _ Drinking Founlain _ Boiler <br /> Floordrain _ Refrigeration <br /> Grease trap _ Woodstovu <br /> Raot drains Other__ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE I;,3105 <br /> I hereby centi(y that I hevo read and examined this application and know the samo to be:rue and correct. All provisions o(laws and <br /> ordinaces goveming this rype o(work will be complied with whether specified herein or ne!.The granting oi a permit does not presume <br /> to give authority to violate or cancel the provision ot any other state or local law regulatin.� �onstrur,tion or the peAormance of t\ � <br /> cons .T a am uthorized by the owner of this property to peAorm Ihe work for wiiich application is made and I compty with the �� <br /> Stat nt �l 827 RCW a d 296.200 WAC. � <br /> � z z � ��� <br /> Signatu ot Owner/ContractotlAuthonzed Agent D e � <br /> ' \ <br /> \/ � <br />