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� � <br /> PERMIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org io _ B i"05 <br /> � APPLICATIONS ARE ACCEPTED FROPA d AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> ISITE ADDRESS Il PARCEL TAX I.D.# PERMIT# <br /> (�Z St: LV�'l'�L� 1�{..1� � <br /> lC�c.�. Z;�C:;«�<:�{(`�,"�.c'..Ct> � , ,� '� <br /> � <br /> LEGAL LOT NO. BLOCK TR0.CT �c a5o�-�a3 i <br /> DESC. <br /> OWNER ADDRESS CITYZP PHON . (,y-1c�) I <br /> � r �p..����c.-..r Z.�-4�l `ol•� �3,�.L�.S�, l�G'+.i�i.�� l�.�u.etM `.�`�Z.� Y�Z ". r` -' <br /> �T c'�y u�> <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �L'� ����.<� S�s:+"" .�.�,.�-C] �C� z3> S"��-61� <br /> CONTRACTOr� AD�RE55 C/ITY2II-P/ PHONE \ <br /> l,t,z�..�' (�.c�1,c�Y PI'.;.�.6f�...<t l 6�"t�c.l,. t?`,�;o �1� (Z`�"`� l C.�'/c.l,c�.�(' C�Z�� J <br /> CONTR.IJCENSE# /< �� � u�" ��I����{ cSv"1-`ZoE; � <br /> USE OF BUILDING HEAT SOURCE �/LSG� CONTRACT PRICE OF WORK <br /> �`�,1,,� _Electric �.Gas_Other � �� <br /> i <br /> WORK DESCRIPTION - <br /> �. ..�i lL�{ ��u�1��.`v.( S�S'�t""' <br /> r <br /> �,:,�,:�2 �.,�t-f �„ ,t����� Fti,��i�, ��-�fi��'�t�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> "� Toilet A/C-air handling units �� <br /> Dathtub Forced air systems ��j <br /> 3_ Lavatory(wash basin) � �L Gas piping � <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace . � <br /> Dishwasher _ Gas renge ' � <br /> _ Clotheswa;her Clothesdryer �1\ <br /> Laundry tray _ Rangehood � <br /> i7� Sink�service'barlmop/etc.) Exhaustfan <br /> �- Backflow preventer _ Heatpump <br /> �1_ Urinal _ Unit heater � <br /> I Drinking Fountain _ Boiler <br /> � Flocr drain _ Refrigeration <br /> Grease Vap Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EVERETT LOCAL SALES TAX COOE IS 31�5 <br /> I hereby cefiU�that I have read and examined this application and know lhe same to be true and wrrect. All provisions of laws and <br /> ordinapes,�gov ming this rype of work wilt be complied with whether specified herein or not.The grenting of a permit does not presume � <br /> to give a�thori to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> j construction. That I am autF.orized by the owner o(this property to perform the work tor which applicaUon is made and I comply vnth Gtie <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> � � � -'1�_--� ,�-w t=; .>, _ ..,_ S ��� �� <br /> Signature 0 ner/Contractor/Authonzed Agent Date <br />