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PERMIT APPL.ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98�01 ���-/ Z"�� <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS G��'"` <br />�y4 5 ut�bL�� �-$; <br />LEGA LOT NO. B! OCK <br />C.SC. Sec a�'�'c�t9 � DO �� <br />OWNER <br />Ro� $ 54�,�f P�.� n�� <br />TENANT NAME <br />� uJ fJ �� <br />CONTR. LICENSE # <br />USEOFBUILDING ���Ve <br />(Lz s � �.2u�tu � s��r��� <br />WORK DESCRIPTION <br />�oW%15"t'a�i•5: <br />H.�rSr'�• �.r S <br />WR <br />TR C' <br />ADDR <br />�5�0 <br />PARCEL TAX I.D. # <br />O 5 0 57ovo0; <br />OR SUBDIVISION R \ 1 � <br />�; <br />CONTACT FOR PERMIT <br />� — HEATSOURCE <br />� .n <br />Electric � Gas ,_ Olher <br />^P5�-�i r�5/=��;flb-�% <br />/4 � 4d'a� �'�'i Wl R.' <br />0 <br />/,ci�/07/ -OC13 <br />ITYIZIP PHONE 1. 0$, a,3'b <br />� <br />flV� san ��� C�` ib-�� <br />PHONE <br />CONTRACT PRIGt ur �rvvnn <br />��B 50. o o (t/��W�r� S <br />��..: �. I c+� a ne 1�i[ �1 fs � <br />�%1'%'Cf�OY �voY�.Zh5T0./��� sN.O�CC �RT.'t2G�'i�5• <br />Moct'�{n v vo m '� (•av.r� D�-'i'y r+oa YVI . 1 Y�S�-Q 1 � <br />n6Wr8 Y'0.1 �• �' Oy�V¢(�'{' <br />NO. I TYPE OF FIXTURE OR ITEM <br />7� Toilet <br />�Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />1 Ciolhes washer <br />1 Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />— Other __ <br />6�� G2. I h'�o cl i7C aCouM �D U <br />J <br />c YhSi-nl1 5�•�-o1G� c5�a.�.Ct'0 <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepia�e <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3706 <br />I hereby ceAify that I have read and examined this application and know ihe same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whelher specified herein or nol. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law reoulating construdion or ihe performance of <br />conslruclion. That I am authorized by the owner of lhis property lo per(orm the work for which application is made and I comply with the <br />$t5�ontradors L w 16.27 RC�y�and 2 6200 WAC. <br />,! � /�� Z ,�-,/a <br />/�� // ''/� <br />' naWre of OwnedContractor/Aul oriz gent D e <br />