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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �/ <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �,�,I 7�,3'�TZ <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICAT O�JS ARE P.CCEPTED FROM 8 AM TO 4 PM i ;` / - �' I'i <br /> SITE ADDRESS � PARCEL TAX I.D.# P RMIT# I <br /> �� Lo� , ✓�i ' � � UG GI� 7u � G y 0 ZI cu <br /> LEGAL LOTNO. �LOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIN/ZIP PfiONE t��j��-S1J> <br /> 7 <br /> .�� ��a�ss �.� za v�, �rn� ��(,��-��o� �t�� � z <br /> TENANT NAME CONTACT FOR PERMIT PHON� <br /> ,� rf� �h � l����l;r yt �-z1 � -.r�, � <br /> CONTRACTOR"�"�?GOh�hc, ADDRESS CITY2IP PHONEUls_f7G '�Z� <br /> i <br /> �NTR.UCESISE# J <br /> � j uyir� �-�G�p �(�-l�. V�iPi�f��,��i/�,•'���. Cf� h��l�r� . j [2✓-�.yyi�z <br /> � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � � i� � �'�f�„ � �C Electric _Gas_Other �J �'� GGL� <br /> YcJ 1/ e/ Lc: <br /> WORK DESCRIPTION /�� , <br /> �� �i, `� � <br /> L- �%? � '� 7� !-�����r�c/ <br /> , <br /> L G h, tva c ��.,� �-E-� C l�ei�• �o 'ti h �Gn+� <br /> PLllMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPF OF FIXTURE OR IT[M <br /> Toilet .3 A/C-air handling units <br /> BathWb 2 � Forced air systems <br /> Lavalory(wash basin)3 '� Gas pipinp <br /> Shower / Waterhealer � <br /> ilchen sink 8 disposal � / Gas freplace <br /> i,hwasher � Gas range <br /> lothes washer/ - Cloth�s dryer� <br /> � Water healer Range hood � <br /> Sink(service/bar/mop/elc.) Exhaust fan y- <br /> Back(low preventer Heat pump <br /> Urinal I Unil heater <br /> Drinking Fountain Bailer <br /> ! _ Floor drain _ Refrigeration <br /> � Grease�rap _ Woodstove <br /> Roof drains Olher <br /> O:her <br /> CITY OF EVERE7T LOCAL SAIES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined this applicalion and know lhe same to ba trce and cerrecL All provisions of laws and <br /> ordinaces goveming lhis type of work�vill be complied with whelher speci(ied herein or not.The granting of a permil does nol presume <br /> to give authorily to violate or cancel the provision of any other stale or local law reyulating construclion or the peAormance of <br /> consWclion.That I am authorized by the owner o(this property lo per(orm the work(or which applicalion is made and I comply with the <br /> Slale Conlraclors Law 18.27 RCW and 296200 WAC. <br /> /�/'�� ���?� r�>y� Z <br /> Signalure o(OwnedCo ractor/Authonzed Agenl Dale <br /> .!��� , � ��- <br />