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�� <br /> PE�MIT APPLICATION <br /> ��ITY OF F'.VERETT PERMIT S�RVICES <br /> 32Q0 CE7AR STREET, EVERETT,WA 98201 <br /> 425-257-8810— �AX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -aG-O� <br /> SITE AD RESS „ �' 3 PARCEL TAX I.D.# PERMIT# <br /> >>�-�� E�,.ws��,� �czy �� �% s��dq-�o� <br /> � - � L✓i <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER. 11U���� �)Q� Q ' JnyY�Qw ADDRESS � '-7�� 9 `�` �VCI jZIP���� PHONE �Zv�/�'7� I�6 <br /> 1 � /> / ��V / <br /> i�l�� �` 5 L��...�� iv�:9'Jc�;c:� <br /> TENANT NAME /" /�� CONTACT FOR PERMIT PHONE r�J(�) �'��, I� LfL� <br /> �?� �] �Jin�l '✓ } c`" .�-r n . / .� _ // / <br /> I�CC t �Ctx � I � ' l�— ' �s L� �� E•MAIL '. • �;L , ,-r n� a va, <br /> CONTRACipR �•���'( L� 5( C{/�+�� ADORESS��U � N� �� C� IZIP P ON <br /> 7 q ," /� / <br /> CONTR.LICENSE# �Gy)�'I�ri (,Llc �(�7 (�r-C ��x r �S v" ��, L f <br /> sCA iTs � �r�u ►zl� ' <br /> USE OF BUILDING HEAT SOURCE CONT CT PRICE OF WORK <br /> _Electric _Gas_Other �/_f v�� � <br /> WORK DESCRIP710N <br /> IL� c <br /> i/i�h Ge �Ji�iw �1I) � . <br /> ' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> BathWb Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Disliwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/badmopietc,) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodslove <br /> Roof drains Other �,L:�✓ .1'&�r��-cz <br /> Other — <br /> CITY OF EVERETT LOC.>L SALES TAX CODE IS 3105 <br /> I hereby ceriEfy lhat i have �ead and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces ycvernir�g Ih!s typu of�.vork will be complied viilh whelner speci(ied herein or not.The granting of a permit does nol presume <br /> to�ive aulhorily to vicl&la cr cancei the provision of any olher stale or local law regulaling construction or the pertormance of <br /> �enslruction.That I am au;hodzecl by lhe owner of lhis proporly to pertorm Ihe work for which application is made and I comply with the <br /> Slate ConUaclors Law 'i8.27 RCW-and'2 6.200 WAC. <br /> ��,"' ;"'j' � — °l /'., r /ob . <br /> SignaWre of' Jwner/Con a�odAuthorized Agent Dat , , (� <br /> f. <br />