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P�RMiT APPLlLAT'�C,��f � <br /> ClTY OF EV�RETT PERMIT SERVICES �j����5 � <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-88'0- FAX 425-257-8857-www.everettwa.o.g s`6 'OS <br /> APPLICATIONS ARE ACCEPTED FROiVI 8 AM TO 4 PM - DFBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX lD.# �P RfMIT# <br /> l p►-. -v-c r - oo i�r-o v I W n'� -J� <br /> LEGAL LOTN . BLOCK TRACT <br /> DESC. � ec . Z3 . 28 n(•, rLqa. 4� C. , IiV. NI <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> h vncs � c _ !o� .S Eucv{ I./-25•03o.1(c3o <br /> TEN NTNAME CONTACTFORPERMIT PHONE <br /> S I n�1 I.ri Ftt tM I I a C ,�„t Y-� �� In S Dvl �`LS f��O I(o O <br /> CONTR TOR �\� �L r ADDRESS CITY2IP PHONE <br /> lJJ0.$-�R�� (�Vls'�--f'��ZM g��p� <br /> CONTR.LICENSE# �1 <br /> ,DAS`T(:fL�tB�F.�i ,�Y15 %bi" p� S.e. �dcrrn (�ItS) �70-��3C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> CIVIG �� r�{�YII�Ie� _Elearic �Gas_Olher I �'��D a0� <br /> WORK DESCRIf'TION <br /> L`oKS+Lu.�.-�- Vl.cnn� SI✓t��.c. -�-uml�� I��eSlc�e,KGL. �/�J�IC_�/�� <br /> / 7� <br /> PLUMBING ME NICAL <br /> NO. ;YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel �A�C-airhandlingunits <br /> y BathWb <br /> .�._ _L Forced air systems <br /> __ Lavalory(wash basin) � Gas piping <br /> �� <- Shower � Water heater <br /> � Kitchen sink&disposal � Gas(ireplace <br /> � Dishwasher � Gas ranc�e <br /> � Clothes washer J_ Clothes dryer <br /> � Laundry tr2� � Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> r _ Backflow preven�er Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floor drain �! Refrigeration <br /> il Grease trap \ Woodstove <br /> __[_ Roof drains Olher <br /> i =I Olhcr = <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions of laws arid <br /> � ordinaces governing lhis type of work will be complied�vith whether specified herein or nol The grantin�of a permit does not p;esume <br /> to give authority to violale or cancel lhe provision of any other state or local law regulaling construction or lhe performance of <br /> consiruction.That I am aulhorized by the owner of this property to per(orm the�vork for which application is made an�• '�nmp!y with the <br /> Stale Conlr�tors Law 18. 7 RCW and 296.200 WAC. <br /> iL^' il - �--'"_� t l 7 Zi'J� <br /> Signatur OwnedCo -ctor/Authorized Agent Date <br /> � --�---------- — �—="�� <br /> l. <br /> ��-�-�;��,.-������- � �;����� � , <br /> �J � 1rW � � <br /> /�q�e�Y.'�.�Y lt'`�.t�,'ry'Q�'< p Mw�A � il <br /> !`RT �" L...3� �.p <br /> ^M <br /> �� <br /> S <br /> 9�� '.�� -Y� i <br /> �f <br /> �'.�� <br /> �t ' <br /> t..: <br /> TM... �.:kdi <br /> ��.;�„�, ��„� <br />