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4 -- - - <br /> PERMIT APPLiCATION <br /> CITY OF EVERETT PERIIPIIT SERVICES �I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �I 425-257-8810— FAX 425-257-8857—vwv�•everetlwa.org i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I PARCEL TAX I.D.# PERMIT# <br /> I SITEADDRESS l�n(7 � ��7U.-�-�,�3 <br /> �`la6 C�o�nY (��� �C���l �la��(�% <br /> LEGHLL LOT NO. I BLOCK 'fRACT <br /> GESC1 I I pDDRE55 CITYZP PHONE <br /> I O\NNER ., . . - <br /> , : <br /> . . , <br /> . i. , . i f�U::./-IIIL'. . �� '.��.:. '� � ` . <br /> "-:`.7 <br /> } i..:�..:.� ' �'�ii;_ , .'i(. 1 �:i, -. ... I <br /> � CONTACT FOR PERM�T PHONE <br /> � TENANTNAME <br /> � I <br /> �lii�-l:� l.�l�riC- �-5�'1 ;� (`'(� <br /> ADDRESS CITlIZIP PHONE , _ <br /> CONTRACTOR - . ;'_G . . �5'. ;r�.,..�i`:•':":(u <br /> � I rl.: �3GL I�'�C-i_Gtl.'- . -1-�� ����' <br /> _:�!:-:BSLLI I �� � <br /> rt`{CG - . � i '-�nr.._:. -�. <br /> CONTR.LICENSE.� �. 1L.�TL''���{4bCf(wttii_:+.t� �.t-�',; . = <br /> HEAT SJURCE CONTRACT PRICE OF WORK <br /> USE OF BUILDING � <br /> / �/ , � <br /> Electric _Gas_Other �%I`""�I � �r �) .U �� <br /> WORKDESCRIPi1��jJ //f�`{ ��/G�) ,���lIG�=1/��n� <br /> � <br /> C ) !/�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM <br /> NO. TVPE OF FIXTURE OR ITEM <br /> A/C-air handling units <br /> Toilet Forced air systems , <br /> _ Bathtub Gas piping <br /> � Levatory(wash baan) \Nater heater <br /> Shower Gas fireplace <br /> Kitchen sink 8 disposel Gas range <br /> Dishwasher Clothes dryer <br /> _ Clothes washer Range hood I <br /> Laundry Vay Exhaust fan <br /> _ Sink(servicelbar/mopletc.) — Heatpump <br /> Backfiow preventer Unit heater A <br /> _ Urinal Boiler Y <br /> Dnnking Fountain — Refr,gerauon N <br /> Floor drain Woodstove <br /> Grease trap — Other�_— <br /> Fioof drains — <br /> Other�� '— <br /> CIN OF EVERET7 LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicafion and Imov+the same to be true and correct. All provisions ol laws and <br /> Iordinaces g 0.veming this type of work will be complied with whether specified herein or not.The granting of a permit dees no:presume <br /> to give auihor�ty to violate or cancel ffie provision of any other state or local law regula6ng construction or the pedormance of <br /> constnictioa`fhaTtBm thon�2d by the owner ot Nis property ro perform Ne work far which application is mad=and I comply with the <br /> State'Con��cfprs Law 18. 7 R� na 296.200 WAC. �y/P (l <br /> %' i ( / <br /> / DAte <br /> Signen3re of UmedContractorl umonzed Agent <br /> 1 <br />