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-- � - ---- -- --���-2 -- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320u CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8E57-www.everettwa.org <br /> APPLICATIONS AR[ACCEPT'ED FROM 8 AM TO 4 PM (� ` I b-('/ <br /> SITE1ADDRESS PAF2C[L TAX I.D. tl PERMIT# <br /> I�l� � ��, � 1�� Cz�SS2 C� G�cdZ_ 1 �O" v� <br /> l[GAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODF2L55 CITY2IP PHONE <br /> F/��/ Goo�. s �o��s /JQko�ti lti �w.P�f `'ys <br /> a`7 z SS 4'rSS�/ <br /> TENANTNAME I CONTnCTFO1tPERM1? PHONE <br /> i — <br /> � CONTRACTOR 11DDI:[SS CITY2IP PMONE <br /> /'j�'jC��.,r�O✓� /�'io3 iv� 6&' S7 A` czao aQeo,/,,,r,hdrv/1- ?joSz <br /> CONTR.LICENSE N <br /> �`i/�i��.s� c9z y/� 5- 4�ss�.�g2o <br /> USE OF BUILDING I — HEn7 SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Oiher y� 94 � <br /> WORK DESCRIPTION n �/ � . . S. /� <br /> rHs�4ir Q .�4� trSS .,�. � . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—airhandlingunits L..e}f-1��F <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes drver <br /> Laundry tray Range hood <br /> Sink(servi ar/mopletc.) Lxhausl fan <br /> Backtlo reventer 1 Heat pump <br /> Urina Unit heater <br /> Dri mg Fountain �oiler <br /> oor drain Refrigeration <br /> _ Grease trap Woodstove <br /> Roo(drains Oth <br /> _ other l �in.a 11 �„•l vr /�+• h � 5�0�.'�" <br /> CIN OF EVERG7T LOCAL SALLS TAX CODE IS J105 <br /> I hereby ceritify that I have read and examined lhis application and kno�v the same to be true and cerrect. All provisions of laws and <br /> ordinaces governing lhis rype of work will he complied with whether specified herein or not The granting o(a permit does not presume <br /> to give aulhority to violate or can I th provis�on of any olher state or local law regulaling conslruclion or the performance of <br /> construction.Thal I am authoi' d b he o er of this propeity to perfann the v:ork lor which app�icalion is made and I comply with the <br /> Stale Contractors w .2" C and 200 WAC. <br /> Q���� <br /> Signature of Ownerl o ra or/P thorized Agent Da; <br /> - �S d � � l9 lo�--- — <br /> YZ <br /> . . ,... <br />