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�---- - -- � � \ — . <br /> P�RMIT AP�'LICATIUN I� <br /> I CITY OF EVERETT PERMIT SERVICES �I <br /> 3200 CEDP.R STREET, EVERETT, WA 9�i201 ��� �� � i <br /> 425-257-8810 — FAX 425-257-8857 — www.eveiettwa.org � <br /> I /� � <br /> �, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �' �'l�'G% -nZ�% <br /> ISITE ADDRESS PARCEL TAX I.D.# PERMIT# _ <br /> � �-��z- o - tb�--� � C ��.3�� o :S�I ���CQ o ► �=}�-,-�--.--�'� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p II <br /> DESC. I I <br /> OWNER ADDRESS CITYIZIP PHONE <br /> r7 �2 r ' 'G L'�jOS - c ����ii <br /> 1 c�_1 -�c I��-iz l�o�� -�,v �, `l�� � �1 �-- <br /> TENANTNA�dE \ CONTACTFORPERMIT PHONE �'ZS-3-+�I'���-' <br /> � � �' �C��_ �.��'�t: �7T�C'S��'X}�V� E ma��q3b:,�Ic�i�n 5 e_a. �z^.�r� <br /> U� � \1Yl� I <br /> CONTRACTOR ADURESS CITYIZIP PHOP.E <br /> G 3 t�x= ���`. 5 �0 42S .3r�{_-���u � <br /> CONTR.LICENSE# n � -31� -SVv \ CI / (_,,� � <br /> C� .� 1���)-����Z�' Iv� �C1�RYl0 S�� `-U1m4til C �--� I�S Z�Z —_ <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK �i <br /> !"�� l�'l> <br /> ��,\�\� _Eleciric _Gas__Olher � � � j� �. li <br /> WORK DESCRIPTION r . � <br /> TV�t�J ��"I x � !-� � VC.ti��-C -' l.'J ��F'�\ v�,.� �'j�� �� I��` �.J'l� ��4 G`G_5 I <br /> J 1 <br /> � (� �� <br /> �v:w `� �:;� L� v,� V ���"-� [ a!r,�-,�, — S C f�a X �lC `� � o� be �C.' i <br /> PLUMBING MECHAiVICAL I <br /> NO. NPE QF FIXTURE OR ITEM NO. TYPE OF FIXTUR[OR ITEh1 � <br /> Toilel WC-air handling unils <br /> BatMub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> � Shower _ Walen c�aler �, <br /> �', Kitchen sink R disposal _ Gas lireplace . <br /> ' Gishwasher _ Gas range � <br /> � Clo�hes washer __ Clothes dryer i <br /> � Waler heater _ Range hood I <br /> � Sink(service/badmop/etc.) _ Exhaust fan �, <br /> B�ckllow prevenler _ Heat pump <br /> �i Urinal _ Unil healer � <br /> �'� Drinking Founlain _ Boiler I <br /> �I Floor drain _ Refrigeration <br /> ' Grease lrap __ Woodstove <br /> � Roo(drains 1 _ Other <br /> i � _L Other 1'�'�?�.q. �1 b — il <br /> i� '� CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I <br /> � I hereby cerilify thal I have read and examined this applicalion and know the same lo be truc and correcL All provisions o(laws and � <br /> ��I �' ordinaces yoveming this type of work will 6e cor�.�lied wilh whether spacifieA herein or not The granting of 2 permil does nol pmsume I <br /> lo give aulhonty lo violate or cancel lhe provision o(any other state or local law regulating consWcfion or ihe per�ormance of <br /> � construction.Thal I am aulhorized by lhe owner of this property to pedorm the work tor which applicalion is made and I comply with the I <br /> 'I e o Iraclors Law 18.27 R and 29F�2Q0 WAC. <br /> �'L���'z%. � � -- �� <br /> SignaWre of edConlractor/Authorized Age f ���e � <br /> ��:� I <br /> - - --- - _ -- — -� <br />