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P��RMIT APPLICATI(.,iV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ��03 SE �m vJ 425-257-8810— FAX 425-257-8857 —www.everettwa.org �� � ►'7 .- 0,6 <br /> APPLICATIONS ,4RE ACCEPTED FRC;�I 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NUT ACCEPTED <br /> SITE AD�RES�,S'L PARCEL TAX I.D.# PERMIT# <br /> � �7L�"7"'_7,'�r__��m�'"/r :� YO 5� � �'o n '/o HS a ° � �0� `�� <br /> � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. �L �.� <br /> OWNER ADDRESS CITY2IP PHONE �O 3�G�'-�� S-S�D <br /> � b� 8301 E %�,�i�-h� /�c� , .Sk�7/O �9/�!Gf,iVo� ��l�;1:3C �� $vlri <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �J-rwtr� - /lleLYlcle. �.�'�i�c�i�ty (.'�'� fcaS ���G�u��'o.v��j�r � COi�Lr.�Lf �f�S-G�70�(e7U <br /> l <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> yZ5- 7�5' �yyo <br /> lJCu�'s -�c!Lc cccECcc2 a p -� d � y c��y A�r tU Jk z�s� '_�/ <br /> CONTR.LICENSE# Li.1lL/1�UZ"K.` r ��� �1S`.J��' <br /> / <br /> USE OF BUILDING HEAT SOURCE CONT CT PRICE OF WORK <br /> ,l'��ZC�-� _Eleclric _Gas_Other � � <br /> r <br /> WORK DESCRIPTION <br /> � mol�hbn � �uw- �i�,vcr's�i� ruzzGL � se c�a,Ft �s'/�j �a.�, ���(�-r--���s �v°� <br /> �,oru����t ��shaa,us� �uw� ��h�ib�� F,,Y- c�Ffi���iz, �itt^dc.z,cs� izec�r c�� ��, <br /> l��y'> . <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balht�b Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> 3hower Waler heater <br /> _ Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/etcJ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinlcing Fountain Boiler <br /> Floor drain Reingeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERE7T LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify that I have read and ezamined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein or nol.The grantinc�of a permit does not presume <br /> fi give authority to violate or cancel the provision of any olher state or local law regulaling construction or the per(ormance of <br /> construction.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with lhe <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> `,�6-�..�,�, �5 �-s��,JOG(.- <br /> SignaWre of OwnedCo trector�Authnrized Agent � Date �I <br /> � <br />