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P�RMIT APPLI�CATI(JIV <br /> CITY OF EVERETT PE:RII�IT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAa I.D.# PERMIT# <br /> i929 ilac;ia�cl f���,iue c�o %�/y�oo�ozSov 0/ � � <br /> LEGAL LOTNO. BLOCK TRACT <br /> �esc. ;��,_�� 3 i����ehu��i' <br /> OWNER ADDRESS CITYIZIP PHONE <br /> J/lGi�l f4�?CE��:ic�ri /yLtj hfutc/tCr�l�L-59'lu� �tiPd'�2{� <br /> TENANTNAME CONTACTFOF'.PERMIT PHONE <br /> �s _i ,�, .. �> / / <br /> (i'T'!,"���, �"F/�/�jr/ �IvG� �O J/'.J GjAtG <br /> CONTRACTOR GW.`�I'O�n :�sIY�.Irw ADDRESS (��j�U^����S��tI(Y2IPE'du��HONE�Z�' <br /> �R�16'�3c yie=�9��9 <br /> CONTR.LICENSE#�(f�i'Yd[-S�S/J SOKS <br /> USE OF BUILDING HEAT SOURCE (�oI'�'P�lic �� CONTRACT PRICE OF WORK <br /> ���•Z�.1� _Electric _Gas_Other <br /> !— <br /> WORKDESCRIPTION -r�� �� � � ��i x GO� IClO� ��=�} �:aw�G bi.�.�lc� ��riJ`4ar4��� <br /> J <br /> PLUMBING r MECHANICAL Nof- <br /> N0. NPEOFFIXTUREURITFM ����i C��=(���������� NO. TYPEOFFIXTUREORITEM Rpp4�ca6 <br /> Toilet A/C-air handling units <br /> BalhWb Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W aier heater <br /> Kitchen sink&disposal C',as fireplace <br /> Dishwasher Gas renge <br /> Clothes washer _ Clothes dryei <br /> Water heater __ Ranc�e hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer __ Heat pump <br /> � Urinal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigcration <br /> Grease lrap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF GVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined!nis application and know the same to be true and corre,cL All pr�visions of laws and � <br /> ordinaces governing lhis type of work will be romplied with whether specifed herein or not.The granting of a permil does not presumc , <br /> lo give authority to violale or cancel the provision of any other stale or local law regulating conshuction or tha performance of �. <br /> construcCon.Thal I am aulhorized by the owner of this property lo perform the�vork for which application�s made and I comply with tt�e <br /> State C trec aw 8�27 RCW and 296.200 WAC. i <br /> tu <" <41,�� a=<.�;i�) i2JLolV�� � <br /> S naWre of Owner/Con�ractod u orized Agenl ��— �i <br /> --.—� <br /> �— ---- _ . __--- - --- <br /> -,asr�. �. ' ,ra,�aP6ar".c•.:va . <br /> ��'AT1s.F�t� z! f C�9Y� <br /> ; <br /> N <br />