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i <br /> PERMIT APPLICATION _ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32�J CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �tJ -/8-lJ 7 <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT tl <br /> �`tl5 Co1G Q � �� U�65'S'4GS'3oo300 �S �10 -I D <br /> LEG/1 LOT NO. BLOCK TRACT OH SUBDIVISION p <br /> DESC. _ - 'c�- � Zf �•— <br /> OWNER � � ADORESS CITY2IP PHONE <br /> .`Xzr /�'s �rry 1060 �(E lG�� �iile W/� `� 1�5 <br /> TENANTNAME CONTACTFORPERMIT PHONE(Y13�'77�-+J+J3� <br /> /� / GG: �S�oFGrr E�liS� newp er.w,�s�lhr�ryneo.+s�5.t5. �nM <br /> 3cC� /V 1 O•1 KC� E.MA1L <br /> y ,> y � j' �Nle��l� W.q 4��3 �4.�i�776•�3, <br /> Pj e�r l���o.� 5��n 5 a �.+,.5 '�4(5 Co�b �Q UG', <br /> CONTR.LICENSE p <br /> 6 c RRYNcp�xti� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �O.�lAIeTCK�I I _Eleclric _Gas_OUier � ��� �[C� � <br /> WORK DESCRIPTION ( I I I <br /> �n6C �CtL� QNC, �..�:iY'4�� �..P �C.� n� �Y�� I�ITGt�A9�y i��U.Yi.�R1Cd GV1n.�•�eI ICf�erb, 3�U�� '+Yw.� <br /> �/7� .ML+��'�� /�(OU.��� G'�1 �',X�Cr nc.� �i� :..te, fcYL'iW.�. GOiIACe'� +.� �..�t r 4'� '�in¢ O{, �.�S/w� � <br /> �J" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ND. TYPE OF FI%TURE OR ITEM <br /> N Toilet 0.�C-air handling unils <br /> BathWb Forced air syslems <br /> Lavatory(wash basin) _ _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal __ Gas tireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) _ Ezhaust fan <br /> �ackllow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Rool drains Olher <br /> Olher__ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3f 05 <br /> I hereby cerilify that I have read and examined lhis application and know the same to be Iruc and correcL All provisions of laws and <br /> ordinaces goveming�his type of work will be complied with whelher specified herein or not.The gran�ing of a permit does nol presume <br /> lo give aulhorily to viola�e or cancel ihe provision of any other slate or local law regulaling consiruc�ion or the pertormance ot <br /> wnstruction.Thal I am authorized by�he owner of Uiis property!o periorm ihe work lor which applicalion is made and I comply wilh Ihe <br /> Slale CoNractors Law 18.27 RCW and 296.200 WAC. <br /> �l�,;.�,i ��,;,{ r��.-1 ��7 <br /> Signalure ol wnenConlractor/Author¢ed Agent Dale ��L <br />