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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES y _� S�� <br /> 3200 CED",R STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCERTED FROM 8 AM TO 4 PM �/� �'�'/ <br /> SITE ADDRESS �Q' � �U�V t �J PARCEL TAX I.D.# PERMIT S _ � <br /> 3 � 4 �1�� �Ga DU <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> �ES�. �9��� <br /> OWNER ADDRESS CITY2IP� PHONE � <br /> Cclty ,=�-�.C'-3t:.c� ��h,tn.ei� s (�Lc . �r-LWc-�r('�y �'c�-Fr.z�,i�%rl <br /> TENANT NAME CONTACT FOR PERMIT PHONE , <br /> ��1'�h1lllG� m�� L[��{� �cl �)Iv1c� (41S) ��,��-��,"L3v�h d�hw�� tiir< <br /> E•MAIL �'7tl't�+ � /p� 1`� <br /> �� T A DR S$ �I / I�—PAa <br /> ��'�j�. �D��cr�}�s � (y�� 37�/ - s3 7 7 '``� <br /> .CW1TArii6EN9tp S1-e v e�--��j�-o �r s ��'l CU►��- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C';,��E'_"�•�Y i a /P11���"� _eie�m� (�Gas_Other 9JV <br /> . <br /> WORK DESCRIPTION / /���/x � /��/� S 11\�f�e �lGe S ��i l� � �� ��/l� �� W/�' �.5� 1/11 $ 1 <br /> �F <br /> c�,�c1 h �5�� � �.� r -('c�r c�i ��..� c'_e v i n y I q r-n p �� � �C� � 3 3 ��t <br /> , , � � ��i :t , �, � �—c�d��� s � c:e��S � �- ✓� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI:CTURE OR ITEM <br /> Toilel WC–air handling units <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W aler healer <br /> Kilchen sink&disposai Gas fireptace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) Exhausl(an <br /> Backllow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain f3oiler <br /> Fioor drein Retrigeralion <br /> Greaso trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERE7T LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerilily that I have read and examined lhis application and know Ihe same to be true and correcl. All provisions of laws and <br /> ordinaces governing this rypc of work will be complied with whether specified herein or not.The granting of a permit does not presum: <br /> to give authonty to violate or cancel the provision of any other slate or local law regulating construction or the pedomiance ot <br /> conslruclion.Thal I am authorized by the owner o(lhis property lo periorm the work for which applica�ion is made and I comply wilh the <br /> Stat{:Contraclor Law 18.<^7 RCW and 29G200 WAC. /� <br /> � � G�-��__� �/�j�(�� <br /> Si Aa ure o OwnedConlractor/Authorized Agent Date �/ <br /> � <br />