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i <br /> NERMIT APPLICATIVN <br /> CITY OF EVERETT PERNCIT SEftVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S APJI TO 4 PM S(.(�� � / <br /> SITE ADDRESS ' ' PARCEL TAX I.D.# PERMIT# ., <br /> � 7O7i 'JLP-��+ ��f�� �$� �1�� �OdDD.'1/D � L�� '��� <br /> LEGAL LOTNO. SJ�i�i BLOCK TRACT <br /> oesc.l �� - o Z��Y <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ����-���� �n�- «�z`i �u�Y, <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> %l�-Jj;1�G�G�GD�v�, i <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> ���?��G DiSPL��c.�J C'FS�(5 5�`�1�,�'-�5�1� '�, '�1�-- -m,�. LZO�o� 7Go'U(o7fl <br /> CONTR.LICENSE# ��j�Q� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclrir, _Gas_Olher �� (r�JZ7, (J'� <br /> WORK DESCRIPTION , ` \ <br /> �os�i��-l�l� v}-�� (,l)I�-U. ?�'�-�fl I�T ��N�Y�G(�l,J <br /> � 06�1� P/� P� �1�a��CL 1-Dc�OC/L'P�� 1�Et ro EXISTi�4�r�iT <br /> Zt � <br /> PLUN�BING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling unils <br /> Balhlub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> �ishwasher _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink(servicelbar/mopletc.) _ Exhaust fan <br /> BackOow prevenler _ Heatpump <br /> � Urinal _ Unil heater <br /> _ Drinking Fountain __ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Olhar_ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX COUE IS 3105 <br /> I hereby cerili(y that I have read and examined this applicalion and know lhe same lo be true and correcL A�I provisions of laws and <br /> ordinaces goveminr�this lype of work will be complied with whether speci(ied herein or nol The granling o(a permil does nol presume <br /> lo give authority to violale or cancel the provision of any olher slale or Iocal law regulaling�ons'.ruction or the performance of <br /> consWclion.That I am aulhorized by lhe owner of this property to pedorm Ihe work for which application is made and I comply wilh lhe <br /> Slate Conlreclors w 18.27 RCW and 296.200 WAC. <br /> ��f��N�C�I.t h-�"•✓yLu-tu.J� . <br /> Si�h`atUr o O�vr��dConlractodAulhorizedAgent Date �/ <br /> Z <br />