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� s <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�ERVICES <br /> 3200 CEDAR STREET, EVERETT, W�>9d201 6 � 3 � �� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � Q� ��� APPUCATION:' �RE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p R T It <br /> a-�i �'v���� .�rt-,�� ���� ,��z�,LG �o �r�cq ao.�aoic� �� �o�- ��� <br /> LEGAL LOT NO. BL CK TRACT OR SUBDIVISION# <br /> DESC.� _ <br /> OWNE9 ADDRESS CITY2IP PHONE <br /> �o�c�h �o�,vt l�l���a L.L-C., 4o��il,;cr� ��.c% � ��c,'��� �d!' %309�7 <br /> TEN T NAME CONTACT F PERMIT PHONE �✓LsO-3'3�n-�'✓�J/ <br /> �AC�C�� �C� ���`�[''iU e�t,�a���cl�ui�.����Pr"o,�l�cC(�,u�t,C�i�l <br /> �x����b C:nti�J(k'!�C' �c.vA s !^,—Yi �Ti'1T��AbR� <br /> CONTR.LICENSE# ��,C�.C-.:JT-C:(O/C�/��� ��(� � �-�',L� `_itP� ��, /�JDC'.(�l. �'la�C�� 3C:CG -'J�-33,j`� <br /> ��A- 9��73 <br /> USE OF BUIL(/pIN , HEAT SOURCE CONTRACT PRICE OF WORK <br /> y,���i�� I _Eleciric _Gas_Other <br /> —J. <br /> WORK DESCRIPTION <br /> I��� Ail��'�v� ��p1� A���d. i� Di� �'r�C�oci�� <br /> PLUMfiING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF Fl%TURE OR ITEM <br /> � Toilet _ A/C-nirhandlingunits <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposa� _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Glothes dryer <br /> 'Nater heater Range hood <br /> Sink(service�bar/mop/etc.) _ Exhaust fan <br /> Backflcw preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkiny Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify t t i have read and examined this application and know the same to be true and correct. All provision;of laws and <br /> ordinaces gover ing this type of work will be complied wilh whether specified herein or not.The graMing of a permit dces not presume <br /> to givc authority violate or cancel the provision of any other state or local Iaw regulating construction or ihe perlormance of <br /> construction.T authorized by the owner of this property to perform ihe work fcr which application is made and I comply with the <br /> Slate Cont�a ors Law 18.27 CW and 296200 WAC. <br /> '' ���� ��13 C`� _ <br /> Signature of OwnedContractodAuthorized Agent Date �/ <br /> z <br />