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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIG�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-6810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT N <br /> ' , �`I l,i�% , lu0v Lc���� JC� I� U�IUCIC�O f � C� C� /Od7'� <br /> LEGAL LOT N . BLOCK TRACT OR SUBDIVISION M - <br /> oesc. I�j 000 ll-c�C� Cv' �-`Siti� � c �''�- <br /> OWNER ADDRESS CITYIZIP PHONE L'�_�_ <br /> r�U<<�t� � v1 � , l�-c.��1.�_ i� C��� �r���en�ou� �A_� `Z �Y-u-CC ?�y8 - ls'� S <br /> TENANTNAME CONTACTFORPERMIT PHONE Lf3-S-b�jj(y -�-�J� <br /> r� 1/�- P►ti�l.�� �c ort <br /> e�a�ivif�:�� h��Ir.�. �2�Lh��: Cc1M <br /> �+N � <br /> f y'._�i�1 ��L��l�1,�,�;n� 7(,� �)� �J-�)4: �'.✓l.�'Yl J L'L �.L��L`7 l��J'�� <br /> CONTR.LICENSE If � � - <br /> t�11L�.`I(L.�`133-C�Z 1J� YO(�� J-c-t� � <br /> USE OF BUILDING HEAT SOURCE I��CONTRACT PRICE OF WORK <br /> �< `j� c��'�GC_ _Electric _Gas_Other � 5 � U j � • � � <br /> WORK DESCRIPTION <br /> �� ' , <br /> ,e - L: ��� j_, - (`e,��Y1��:Y� 'i- v'-��J�[�c.� � � 15 )1 �� YL'� �— <br /> l, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhausl fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7NC CODE IS]105 <br /> I hereby certify thal I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinances goveming this type of work will 6e complied with whether speci6ed herein or noL The granting of a permil does nol presume <br /> to give authonty to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am aulhorized by the owner of this propeRy lo perform lhe work for which application is made and I comply with the <br /> State Contractors Law 78.27 RCW and 296200 WAC. <br /> G � L��'V\ �1 �_� ' `� <br /> Sig ature o OwnerlCoC crodAuthonzed Agent Date <br />