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� ' . ---( - �_ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810—FAX 425-257-8857—vw,rvv.everettwa.org <br /> � � PPLIC�TIONS ARE ACCEPTED FROM 8 AM TO 4 PM / /� <br /> l//.��l �"-i i��f l,�_���-,� O —�/— <br /> SITE ADDRESS PARCEL TAX I.D.# pERMI �{ <br /> � ^ <br /> � e a ia ���94 21�n/D/;3o; � ,l�l�� -.SI <br /> LE LOTNO. BLOCK TRACTORSUBDIVISIONI <br /> DESC. <br /> OWNER ADDRESS CITYZP PHONE <br /> See a-1-Fa.ched lib� <br /> NANTmun1� Ir�� I��ONTACr�FO,�PERJi11T �e� �r. PHONE,{�356-�1155 <br /> 8 �M� <br /> e.Ma��1�2. bYDu%�����O rt`,i• <br /> TBD — �n#orma-lion <br /> lu�— p� <br /> CONTR.LICENSE�/ W�I � pro��� a'�'� � ���1 �er {'125 }�,n <br /> de�mihcd <br /> USE OF BUILDING �1 �� HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ' JW 1 f T �3TZC�IG'\ _Eledric _Gas_Other N/� �D <br /> WORK DESCRIPTION �nS�I I ��1.� B1t� � �� e �� (�' V'�.�'G'�'t' <br /> S,e�e._ �L-�ta-i=�c1. �fo'/. plar� �-�--! -�r- �a.�r rev►�u.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> Toilet AfC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backfiow preventer Haat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J705 <br /> I hereby certiy that I have read and examined this application and know lhe same to be true and cortect. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting of a pertnit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction. That I am authorized by lhe owner of this property to perform the work for which application is made and I comply with the <br /> State Contracfirs Law 1827 RCW and 296.200 WAC. <br /> �- 6• 25• o <br /> Sign ure of wner/ContractodAuthonzed Agent Date <br />