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t - - <br /> _g-o � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTE� FROM 8 AM TO 4 PM <br /> SITE ADDRESS PAflCEL TAX I.D.N PERMIT R <br /> - 'r:'�;�► a Lv�� ��l�i vo�l�, 3c�,� ���vo ��SG� - ots� <br /> L[GA LOT NO. BLOCK TflACT OR SUBDIVISION M <br /> OESC. <br /> OWNER ADOflESS CITVZP PHONE f} �Sa �oh <br /> �3��k ��� ,n,.G�� Aa�a Co�by Itve �k. � �v�,rett �r�an i <br /> tENANTNAME � CONTACTFORPERMIi PHONE �C1Ia � '4a'4p <br /> B -r ➢�v�lo��me�v�,1' I �1'� ��.'1 .�1 (iy E-MAIL ���a65XJu.�'��/Wy iNc. <br /> �� � <br /> ��oc�a�c��r��,� 3��'t �� �3a� s� Sea�tle as �as acb �4 aa4s <br /> CONTR.LICENSEM �SSUGICL I{�dUU� h <br /> /�,�/�;�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5�1q a�t�-�a< < _ I ��� ' <br /> Eleciric __ Gas__Other FV <br /> WORK DESCRIPTION �� � �e� � . re f� <br /> JCC a'�-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OH I7EM N0. 1YPE OF FI%TURE OH ITEM <br /> Toilet NC—air handling units <br /> Bathtub Forced air s��stems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> __ Kitchen cink&dispo;al _ Gas tireplace <br /> Dishwasher Gas range <br /> � Clotheswasher Clothesdryer <br /> Water heater _ Range hood <br /> Sink(service/badmop/etc.) _ Lzhaust fan <br /> _ Oacktlow prevenlBr _ Heat pump <br /> Urinal __ Unit heater <br /> _ � Drinking Fountain F3oiler <br /> Floor drain Rr'ngeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> , Othor _ — <br /> CITY OF EVERETT LOCAL SALF.S TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined this app�ication and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this typo of work will be complied witb whether specified berein or not The granting ol a permit does not presume <br /> to give authority to violat3 or cancet the provision ot any other state or local law regulaling consWciion or the pedormance ol <br /> construction.Thal 1 am authorized by the owner ot this property to pertorm ihe work tor which application is made end I comply with the <br /> State CoNractnrs Law 18.27 RCW and 2962U0 WAC. <br /> 1,,1�C�! ls \;fl v��'.� d- 8 - ��" <br /> Signature of edContractodAuth ed Agert Date <br />