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--� <br /> PElRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRGEr, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P �D f U` - O l � <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> /"'' ��� cvtr�t �� /��� �� l��`' "c' ' ' vo vyZtx� '; o v-� <br /> LEGAL LOT NO. �LOCK TRACT OR SUBDIVISION# <br /> DESC. ���'�. Q <br /> OWNER AD'JRESS CITY/ZIP PHONE <br /> L v�,�t��-(— J/l(c.!l LG �� '�/J ' ' \ (I}/c /� '/ / � ,, <br /> � l� 4'��w 1 / ��VL V� I�/%I�SWJ"ryl �/`/�'�y`.� <br /> )(�� <br /> TENANT NAME CONTACT FOR PERMIT � PHONE yG,�,_ �,L>/- »6� f{ <br /> r � Fr�..F�'� <br /> � � J 1 <br /> � :✓��, ��,.-U � G'-" /1'1/L�.�t� Ch'-/�C C�Ji �l�L�iYG'�-1 �L E-MAIL [".�i/9G �Cc' E f� +.�4'—�4:-. <br /> 'CONTRAC1TOft. ADDRESS � CITYIZ�p HONE " <br /> L,1 f��GcGr�y�L�� . 1i��. '�Z-z /(7n;,la.-S1 � �L.� ilic �e?�'!,'ar- ���G• � GL'3 5 <br /> CONTR.LICENSE# ✓ b„�q;{- J�- � h SCcJ � <br /> c_.%tyj�.� � 9ss Kj <br /> �7���. � S <br /> USE OF BUILDING HEAT SOUFcCE CONTRACT PRICE OF WORK <br /> Electric Gas_Other �/� ��+ <br /> G'dGll{G�t-'r 4 �✓ — — Glp�^-' <br /> WCRK DESCRIPTION - / n / ./ � - <br /> G.�:'G,--cJ �-c'S /j,✓v�,.,-., /-v i'lce-c'�f�f/�/? .S/-6•>cC�.f F -! <br /> �L'� ���! .�F( �� �(�G(1 �f)�CL.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ A/C-air handling unils <br /> Bathtub Forced air systems <br /> �� Lavalory(v�ash basinj _ Gas piping <br /> ' Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothe;washer Clolhes dryer <br /> `� Waler heater _ Range hood <br /> Sink (service/barlmop/elc.) Exhausl fan <br /> BackOow preventer Heatpump <br /> Urinal Unil heater <br /> I � Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat 1 have read and examined this apptication and know the same to be true and correcL All provisions o(laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to vio{ate or cancel lhe provision of any other stale or local law regulating consiruction or the performance o( <br /> consiruction. Thal. am authorized by the owner of this property to perform ihe work for whi�h application is made and I comply with the <br /> Sla!e Contraclors�aw 1A,27 ftEW and 296.200 WAC. <br /> �-�J�`% /� /��-' C��`� - f'L <br /> SignaWye'of OwnedConlraclorlAuthorized Agent Date <br />