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i <br /> � � - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> 113cr E-Iw 99 004yz.900 � � o Sc�3 � loo(v - oo� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION• �'O .0 ``,,\�- <br /> DESC. �� O�J � OC�� I �P u� ��`� <br /> • �1 J� � ; ` C�`'.�(:\ C c ADDRESS CITY2IM PHONE <br /> ']_O(c'� �7 '�05�5 <br /> / <br /> , % �r �����c.,� de�o l l �-1 •z f�- '-17�^ 171 wc.e A�1= S ec_i� C � Y�//a <br /> � TENANT NAME CONTACT FOR PEf2M1T PHONE �_ l�zl���;j�� <br /> 1 <br /> ��TO ZC:I� 'E� = Qr �l ���tic _� e..�w� �o�ll '��eY.ulSrsu;ic�"'l <br /> TRA T <br /> DNE i - ��. <br /> eY S��ti���Q�u�'�k5 2608 f��Y 4� ��+ 36r,- Y24- 1325� - <br /> CONTR.LICENSF.tl MeY��o��^ E 11�.._ �r/�U0 Y �� G�. ,� <br /> .0 a'C�(J�l y I <br /> USE OF BUII.DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /���y �q�-�S ?E�l ' 5�;��Q, _Eledric _Gas_Olher 1 �� �� <br /> I <br /> WORK DESCRIPTION /� I � <br /> �L) W G�1 � 5 � c�r� � u r� c�. �� � -1y �e� Si��r��. i tr`� S l �;n <br /> I PLUMBING MECHANICAL <br /> i <br /> I ND. TYPE OF FI%TURE OR ITEM N0. NPE OF FIXTURE OR ITEM <br /> i <br /> � Toilet A/C–airhandlingunits <br /> i _ Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 d;sposal _ Gas fireplace <br /> . Dishwasher �as range <br /> Clothes washer Clothes dryer <br /> I = Water heater = Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> � _ BackFlowpreventer _ Heatpump <br /> I _ Urinal = Unit healer <br /> Drinking Founlain Boiler <br /> 'I Floor drain _ Refrigeration <br /> � Grease trap _ Woodstove <br /> � Roof drains Other <br /> I _ Other — <br /> i I I ^ <br /> j CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> I <br /> I hereby certify that I have read and examined ihis application and know the same to be true and correct. All provisions af laws and <br /> ordinances governing ihis type of work will be complied wilh whether specified herein or not.The granting of a pertnit dces not presume <br /> to give authoity to violate or cancel the provision of any other state or local law regulaling construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to pertortn the work for which application is made and I comply with the <br /> State Contractors Law 8.27 CW and 296200 WAC. <br /> �j��c�,`"iL�r 3--�.�—2v1 v <br /> Signa�ure of OwnedCon ractod uthonzed Agenl G _ ( Date (/Z <br /> S�O (O � <br /> I <br />