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PE� .MIT A.PPLIC�eTIOt� <br /> ClTY OF EVERETl' PERMIT S�RVi�CS <br /> 3200 CEDAR STREET, EVERETT, WA 982�J5 <br /> 425-257-8810— FAX 425-257-8857—www.everetteia.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM T� 4 PM - DEP,IT 8, CREDIT CARi)S ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �UIb Sfz L'V ��-l' ir(�rCC_ �1'/, 'LOa _SI� c�O7 G4!P �v I �0([D/-U'�3 <br /> LEGAL I..OTNO. BLOCK TRACT <br /> DESC. <br /> OWN[R ADDRESS CITY21p PHONE <br /> G—titc� +', ��c, ' U �i �;nc—Y c��E IolO ���.�tc-�utr M1J���Y i G�N2G-7r 9�zog <br /> TENANT NAME CONTACT FOR PER6SiT PHONE I <br /> F/tf2iUC�5 INSukii�G� I Vi��i �CU��IvG�, p�`,IGN lrK��� L�zS' (�7� �(n7�G <br /> I CONTF.4CTOR — ADDRESS CITY2IP PHONE I <br /> CONTR.LICENSE# ' <br /> / � <br /> I �� l� �_' <br /> � USE OF BUILDING — HEAT SOUKCE �IJTRACT PRICE OF WORK <br /> I ����-�y Electric Gas Olher I � 7�J� v�;� <br /> WORK DESCRIPTION I <br /> pL�w���11DN� N��U I�Ht?�i ti7oN�i �r�t�iZ— �"GL�17ak=, Pf�7'U�f (R-� l�i fil�llSll(��' <br /> PLU14161NG MECHANICAL I <br /> NO. TYPE OF f-IXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingunils <br /> _ Bathtub Forced air sy�tems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower VJaler heater <br /> � Kitchen sink�8-diapoazl Gas fireplace <br /> _ Dishwasher Gas�ange <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ S��k(service/badmop/etc.) Exhaust(an <br /> _ Backilow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Bui�er <br /> __ Floordrain Retrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains Olher <br /> Other — — <br /> CITY OF EVERETT LOCAL SF.LES 7AX CODE IS 3105 <br /> I hereby ceriti(y that I hava read and examined this application�nd k�ew the=ama lo be true and correcL All provisions of laws and I <br /> ordinaces governinr� this type of work will be complied wilh wne:he�epec�fied herein or not.The granting of a permit does not presume <br /> � to give authority to violate or cancel ihe provision of any olher state or iocal law regulating construction or the per(ormance of <br /> construction.That I am duthorized by the owner of this property to pertcrm the worh for��•hich application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �C <br /> ='^"�t " �1 ' /-<?s-oL <br /> Signature of OwnedC n ractodAuthorized Agr,nt Date <br /> - -- ��z I <br />