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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7, WA 98201 <br /> 425-257-b810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED i ROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT#/�/ <br /> � � � �JcrLl�R.z£��! 1.�. A- CnY�f 25oof/o�yoy_ A- �[�`*'� <br /> LEGA LOT40. BLOCK TRACT d��i - �v4429�`l�� z3v3 <br /> oesc. po,.v v vzq o0 4 o z 3v/ <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � UL//�- UYVi.-�JQYhY�CYK4-i I�ANni�MG'1.�1 �ZO N. ��AN� DIV� I9��U�."� 4+IfN�•1`L.CA� / I 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 5�"3�,2Bv,tICL I ��-�-v i,�J�-,�,yti,�... 3Lo-�i7-�SaS <br /> C QNTRACTOR AUDRESS CITY2IP PHONE <br /> lLri� vv1�'za.�ic.�-1 �� � I �u.�i +Oti�u.ti �u�.l�tiSroN ��.L3i - 310-7S7-L � <br /> C/p�NTR.LICENSEp C <br /> Kl�'Y1�EL� ii / ��l.-� - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,�.,�,-.'1 — — — nn��3.�� <br /> Eleclric Gas Gther y�pU <br /> WORK UESCRIPTION {OP ou i ��il.r�h�..,� u/�)-s��. vt-� �� I- wnTi.� /:��,,••� U:VCIt,f.l�Kuu sC <br /> DvN � by oiiK-� t . ,.� st.xL snr�bµ��-L -�,xI4.�LL, + �yu�,..rl�.'%. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 2 Toi�et A/C-air handling units <br /> Balhtub Forced air systems <br /> 2 Lavatory(wash basin) _j_ Gas piping - '�^-��^ ���1 +^ S.'^`^' 4'• '�"- <br /> Shower l Water heater <br /> �_ Kitchen sink&disposal _ Gas tireplace <br /> �_ Dishwasher _ Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry lray _ Range hood <br /> 1 Sink(service/badmop/etc.) _ Exhaust fan <br /> =F BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ �oiler <br /> Floor drain Reirigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> �_ Olher m�u. F���o_ — <br /> IUA-l^L�- C..nn..t,u�t+- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know lhe same to be true and correcl. All provisiens of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> to give authoriry lo violate or cancel the provision of any other state or local Iaw regulating construction or ihe performance of <br /> construcC n.Thal I am aulhorized by lhe owner of this property to perform the work for wtiich application is made and I comply with the <br /> State C tractors Law 18.27 W and 296.200 WAC. <br /> '`l t�i v�— <br /> Signature of Owner/Contractor/Authorized Agent Data <br />