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( � <br /> 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, IM1'A 98201 <br /> 425-257-8810-FAX 425-257-8857-wyvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM $_� �-Q� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> 1�_�2 I Q�� �' �.l �!- l cJ � �aoo , r����.1 l <br /> LEGA LOTN CK TRACTORSUBDIVISIONN <br /> DESC. <br /> O�WNE�R ADOAESS CITY2IP PHONE <br /> �.U�1111�Ys�' �Q LI.L �UV �i� `[� 1�OR(� � /, <br /> '.� � •l�i- � .}'nCl'�'C. � 7ffLx�_-- <br /> TENANTNAME � CONTACTFORPERMIT PHONEc4� ri��1-S��IO <br /> \, . �� a w I "`�"" V1�a ,,�� �ticn LI.0 e�a� bw4f c l�n�- . .las_ � <br /> (:tnti_�d 1c:.9 ��, etioi, l-U- �0 ��( �oLl�t ��n�(b� .�'h.� q39 -���t1,`� <br /> CONTA.LICEN Ep ��N(�DCLCCUI't� �tiA �i`�U�a <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> •���u I �'=Electric ��Gas_Other �j.� ���• �O <br /> WORKDESCRIPTION ,��'r10�i'�'1�0"1 J{ '�LlS�ly �Gr�1'fl��'1 �ti�, �m� i`c�1Pe�f'��jnua�., <br /> t� �.r�:�• ��� �� <br /> I'�w �[:.r-tl�-t Lh t�Ob n C�c.zSf- '�'{Ya r�k.:�Q,r�i,r�s�-�'�i w`�� `-"'1..` ` <br /> �Y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> �athtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ C�othes dryer <br /> Wa!er heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit hea�er <br /> Drinkir . -ounlain Boiler <br /> Floor drain Reingeration <br /> Grease trap _ Wocdstove <br /> Rool drains _ Olher <br /> Other <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> i hereby ceritify that I have read and examined this application and know the same to be Irue anc'correct. All provisions of laws and <br /> ordinaces governing this t�pe of work will be complied wi�h whether specified herein or not.T:�e graiiting of a permit does not presume <br /> to c�ive authority to violate or cancel ihe provision ol any other state or local law regulating construction or the pedormance of <br /> constmction.Thal I am authorized by the owner of lhis property to pedorm the work for which application is made and I comply with ihe <br /> State�enlrac\ors aw 78.27 RCW and 296.200 WAC. <br /> a �.�� � �� —o� <br /> Si ure t OwnedConiractodAuthorized gent Date <br /> lZ <br />