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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR�c f, �VERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM �� .-�,0 �S <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I% i � 7 � l l <br /> f � � i � L C-V�o�i I n^�1 t I t.✓A.: Y <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS i�_ CITY/ZIP PHONE <br /> _ � ��� p� t :cfc_C1 ..`1 �C: WC' 'tYvlul�L. � �� `�,.u�i2ci ..-;��� �it�t '-�� <br /> �;:�_t t '�;trrt.t �.I-1c, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Sc: : L�i'tc.c.�.c. i- 4.mZ��zv.c�' �Qu�"n. �����.�z,.?,� CJic t.;�,, Z "tr � p <br /> - f ' <br /> �.Unl C�v,-1-F� J <br /> CONTRACTOR � ��:.�.f:*-����'� ADDRESS CITY2IP PHONE <br /> �i�,.�.'1C1}Ylt�l2f ��lit.i l=lA'� L. �,'���;;..:��� l�S��' ,1� y c'.+-c� S�� ><f. 9�"t-'� i.J.�i `f��i, �.j <br /> CONTR.LICENSE ft <br /> 1� -J�: r-�=c�i� v.�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ` �i �:�2. S1r_i��`� � <br /> � <br /> �"�' � _Electnc _Gas_Olher -� � � �� <br /> � <br /> WORK D[SCRIPTIOPI <br /> �(�:� Ll_L�. ��Q�.J (- /��l`�(�i� F—i �P :��.t ��f-r S 5�0�1 �`y':� �-.�Y�7 ..i� C[,.-..��t, � <br /> cY� '�''^� <br /> ,•'G:�,,�'� -{i:✓" 6t (�i..: ,�.-, J <J.,'_� c f���.�1 � ��'b �-c'c.�1-�,:, con.r,�_iY.,� (Z-c�.. � . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet A/C-air handling units <br /> Bathtub Fcrced air systems <br /> Lavatory(�.vash basin) Gas piping <br /> Shower Water heater <br /> Kdchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry Vay Range hood <br /> Sink(service/bar/mopleta) Exhaust(an <br /> Backflow prevenler Heat pump <br /> Urinal i Unit heater <br /> �I _ Drinking Founlain _ Boiler <br /> Floor drein Refrigerelion <br /> 'I _ Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> _ I-,�.�- S.� t�<�. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihal I have read and examined�his application and knowihe same lo be true and coRect. All provisions of laws and <br /> ordinaces governinc�this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoritp to violale or cancel lhe p�ovision of any olher state or local law regulating conslruction or the pedormance of <br /> consUuction.That I am authonzed by ihe owner of this property to pedorm the work for wliich application is made and 1 comply with the <br /> State Con�ractors Law 18.27 FCW and 296.200 WAC. <br /> �- / <br /> �� I� /A ' F V A �:�� G � I �����-�� U� <br /> SignvureofOwner/Conlractor/Authod edAgant � Date <br />