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�� <br /> � — -- <br /> P���IT �p����/4l�0�11� <br /> CITY OF EVERETT PE�RMIT SERVICES s �6 -G5 <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —wv,�w.everettwa.org <br /> P ��� s��- `(.�- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P.ERMIT# _ <br /> i-` r��. �- � <br /> r. �v�r�e alol szoo ooi3 _ _ � <br /> LEGAL LO. O. BLOCK TF.ACT <br /> DESC. � h CL• Z$ t. WI1i . <br /> OWNER ADDRESS CI ZIP PHONE <br /> �/G .� �bu� �'DYN{S f1�L'l�lV.l.�^�-� /�C,�i �'��S-Cl/r� P�. SE FiV�Y-L-�'� �'ZS•9�-O• �Io3U <br /> TENXNT NAME CONTACT FOR PERMIT P1fONE <br /> �I'.'IL�_�LtW:IlL1 �AM'-�'y�'� 1N.SOYI �ZS• t3�0• ��D"'3n <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Coas�-u� Cov,s+-cu��l-i�-v� 3'f zs qbt'' P�s E� L`f��% <br /> CONTR.LIC�NSE# J C�E�T <br /> Co�sr�rza��r� � wrt>r� qS�w9 870-1b3� <br /> USE OF BUILDING HEAT SOIIRCE CONTRACT PRICE OF WORK <br /> SI•Yt _ � _ r_ Fyl��y _Eleclric �Gas_Oth�r � I I D DDD� ^ <br /> �1�' � <br /> WORK DESCRIPTION <br /> Cv11s�Yu.vF W+-+�J Sl n5 Lc. 7un�i b� �sl�-vi c,e_ � _ _ � <br /> �_���� ��— '�! �- 1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> � Bathtub � Forced air systems <br /> _ ?,' Lavatory(wash basin) � Gas piping <br /> _� Shower � Walerheater <br /> � Kitchen sink&disposal � Gas fireplace <br /> � Dishwasher � Gasrange i <br /> � Clolhes washer � Clolhes dryer � <br /> _J_ Laundry lray Range hood �, <br /> _ Sink(service/badmop/etc.) � Exhausl fan ��� <br /> ; Back(low preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floor drain \� Refrigeration <br /> - Grease trap Woodstove <br /> i _ t_ Roof drains = Oth2r <br /> Other <br /> � CITY OF EVERETT LOCAL SA!_ES 7AX CO�E�S 3105 � <br /> f I I hereby centify that I have read and examined this application and knor�the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type of worl;will be complied with whether speci9ed hF:rein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision ot any other state or local law regulaling construction or the performance o( <br /> conslruction.That I am aulhorized by the owner o(this properry to perform the work for vihich applicalion is made and I comply with the <br /> State Contract rs Law 18.27 CW and 296.200 WAC. <br /> �.��. D S�p f s <br /> Signature of Owner/Contr dAuthorized Agent Dat� <br /> �2 <br /> s;A-. <br /> , f_ <br /> M <br /> e� <br /> �a,:.,.. �riiq ' <br />,... .�. ._. . -�: _... . ..... . .._.. ... ...... . . . .. . .. . . . ... ., . ._.. . . . . <br /> � <br /> , . <br />