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--------; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�OAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425•257-8857—www.everettwa.org <br /> APPI.ICA710NS ARE ACCEPTEO FROM 8 AM TO 4 PM ��� ��9 <br /> SI7E AODRESS PARCEL TAX I,D,tF PERMI7# <br /> ic�21 Ccl w�or� Ia�ne 9/ Z <br /> LEGAL LOT N0. BLOCK TRACT OR SUB�IVISION B <br /> OESC. <br /> OWNER ADDR 53 CITYIZIP pHONE <br /> �C�G�P.� (��V� � �OZI �c�1q2.v�bre, �q►�7_o3 �'' 501 Ifoy'l <br /> i't't, <br /> TENANT NA/ME / "--C-�ONTAC7 fOR PE�RM( IT PHONE �I ' Cj ' I O� <br /> ��C.�(_itt�.� G V v V'C�� I I t,�.�(�l Vr 1 I I l. !.� 1 i I�� E.MAIL�1 VGlql�`�GCI t <br /> -J <br /> ��{��V l �Gtl.�t V10� ��(O(b ��fj.�tiG�I�CC�� �� �cr� �{�- � <br /> CONTR.LICENSE Jl <br /> � �6?�� �25 ZSZ�1 `�' W. <br /> USE OF BUILDING HC•AT SOURCE CON7RACT PRICE OF WORK <br /> _,,,Eloctric � Gas_Other I �`J`JC, — <br /> WORK DESCRIPTION � <br /> I�1SiZl�� �Y1� �P <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toilot AIC-air handlinp unils <br /> Dathlub _ Forced air systems <br /> Lavatory(wash basln) Gas piping <br /> Sho�vor W ator heater <br /> Kitchen sink&tlisposal � Gas tiroplaco <br /> � Dlshwashor Gac rangc <br /> Clolh�s wash6r —' Clulhes dryur <br /> Walor hootor � Rango hood <br /> � Slnk(corvlco/barlmop/olc.) Exhou�t fon <br /> Backflow provonlor � Heat pump <br /> ^ Urinal Unit hootor <br /> � Drinkinp Fountain Boilor <br /> Floor drain � Ro(rigoratlon <br /> Graaso trap � Woodstove <br /> Roof drains Othor <br /> Olher <br /> CITY OF BVflRETT LOCAL SALES TAX CODE IS�105 <br /> I hereby coritify lhat I havo road and oxamined lhis appllcation and know tho same to be truo and correct. AII provisions of Iaws and <br /> ord6iaces govominp this typo of work�vill ba compliad wilh wholhor spoci(iud herein or nol,Tho graNing of a pannit doos not presume <br /> 10 give authOrity to violato or cancol Iho provision Of 2ny olhor slato or IOcal law regulating conSWclion or iho poAormance of <br /> constr4Clion.7hat I am�uthoriZOd by th0 owner of thls property to porform lho work for which applicalion IS m�do antl I comply with thu <br /> _ Slale CunhaWurs L�1027 RCW ond 296200 WAC. <br /> � 11.���uG�. I I �2( D`f <br /> Slgr�;�uro ol vneri�onlraclor/Authonzed Agent Oato <br /> V <br /> i�T'd L588L5z52bi �01 �1�0'J� £O�cO 600z-�2-Nflf <br />