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PERMIT APPLICATION <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE S PARCEL TAX I.D.# PERMIT# <br /> � r7 0�/ t3.�-i-:� oo�� �, �o0 9 c�o� C'_ �c� - a�o <br /> LEGAL LOT NO. BLOCK2 TRACT`O/R SUBDIVISION# <br /> DESC. .� , ._l Z V r ,n G �' . <br /> OWN=R ADDRESS CITYIZIP PHONE <br /> i��(.( , ��X�� IQ 1�7 L�tif6�� �r/� CU� <br /> TENANTNAME CONTACTFOR PERMIT PHONE J/�'-�� .`r��7 -" ' <br /> S�]�� � I �.-n�,, Y <br /> YI U�� � �1'Dl�l SL�7J.D7��t:c/�� E-MAIL <br /> CONTRACTOR �-QDDRESS ("' C�ITYIZIP PHONE <br /> 0�(JNE�2 �t'rt� � �,s�-��ro..t ,�v,,,-,.s� 1,�.�/ti�R-cizuZs <br /> CONTR.LICENSE# P��``..C�C ��j I!�(� <br /> USE OF BUILDING �' Z I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �`Si D�,J'���(� S��� �%�'J/W �Electric _Gas_Olher ��� UUG <br /> I <br /> WORKDESCRIPTION ��v� S,(pµ�� �/2f/ {�D//7�N l� �'/�% � Gl- FCoUS� d�f�c� ��"��- <br /> I�J �?12Sr �'LtoO•- �2L'C=i.Y�-.:i�r'N, _ /'DGfn/O.'�`�- <br /> ���f, � <br /> C <br /> PLUMBING MECH.4NICAL <br /> NO. TYPE OF FIKTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM17 <br /> Z. Toilel A/C-air handling units <br /> � Bathtub _ Forced air syslems <br /> 2 Lavalory (wash basin) _ Gas piping <br /> �_ Sho�ver _ Waler heater <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clolhes dryer <br /> Water healer P.ange hood <br /> Sink (service/bar/mop/r,lc.) � Exhaust(an <br /> Back(lo�v prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> I _ Drinking Founlain _ Boiler <br /> Floor drain Retrigeralion <br /> Grease Vap _ Woodstove <br /> j Roof drains _ Olher <br /> ,I � _ Other — <br /> �� I GTY OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> I hereby cerilify ihat I �iave read and eaamined this application and know the same to be lrue and correct. All provisions of laws and <br /> � ordinaces governing this type of work will be complied wilh�vhether speci(ied herein or not The granting of a permit does no!oresume <br /> lo give aulhority lo violate or cancel lhe provision of any olher slale or local law regulating conslruction or the performance of <br /> conslruction. Tha);1 am aul7oriz d by the owner ef this prooerty to perform the work for which applicalion is made and I comply wilh the <br /> State Cqntr�clorr�t'Law 18�27 nd 296200 WAC. <br /> / / � l� i �� d U <br /> �� `l ' Gl�;,�oi �� <br /> ! SignaWre of OwnedConlraclodAuthurized A ent Date <br /> i �__� �z <br /> �----- - - <br /> it <br />