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i PERMlT APPLICATION <br /> �I CI�Y O� EVERETT PERMIT SERVICES 'i <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 i, <br /> ' 425-257-8870—FAX 425-257-8857—www.evarettwa.org I <br /> � - � �-Od <br /> APPLICATIONS ARE ACCE� fED FROM 8 AM TO 4 PM I <br /> I SITE ADDRESS PARCEL TAX I.D.# PERMIT# -� I <br /> 1U�0� wn ��-. �r�� � S.s z3 c�� v 1�����'C�1� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. II <br /> OWNER � ADDRE'i5 CITY2IP PWONEC Y � <br /> G <br /> �'" 9 1���i1'k�� �������f � � (r�-, Sivsrs ��� ���� 7-1-Cl�� <br /> TENANTNAME Irfl CONTACTFORPERMIT PHONE <br /> I <br /> IJ <br /> CONTRACTOR L�(�.zfL,� ADORE55 CfTY/ZlP PHONE <br /> / ` � <br /> CONTR.LICENS[#/ ^ I� �J�� � �/�l� �. <br /> C�L_/1 ` �J <br /> USE OF BUILOING I -- HEAT SOURCE I CaNTRACT NRICE OF WURK ��' <br /> I <br /> Ele tric _Gas_Other i <br /> WORK DEaCRIPTION I <br /> � <br /> I �.�� '-�G Lt S r- � <br /> PLUMBING MECHANICAL ( <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TVPE OF FI%7URE OR ITEM � <br /> I — — I <br /> _ Toilet _ AIC—airhandlingunits �il <br /> Bathtub Forced air systems <br /> Lavatory(vra:,h hasin) _ Gas piping � <br /> i _ Shovrer Wat�r heater i <br /> Kitchen sink 8 d�sposal Gasfireplaca <br /> Dishwasher tias range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sir�k(servicelbarlmopletc.) _ Ezhaust fan I <br /> Bacictlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountair. Boiler <br /> Floor drain Rofrgeration <br /> Grease trap VW odstovo <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERET7 LOCAL SALES TAX CODE'S 9705 <br /> I hereby ceritify lhat I have rPad and examined llifs application and knowthe same'o be We and cortect All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein cr nat The granting oi a pertnit does not presume <br /> to give authority to violate or caucei the provision of any oth.er shate or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of tiiis property to peAorm ffie work for which pplication is made and 1 comply with ihe <br /> State Contradors Law 18.27 RCW and 296200 WAC. <br /> i ��—'--- Z' � � �� <br /> Signature of OwnedContractodAuthonzed Agent � Dare <br /> I <br /> �-- <br /> i. <br />�-. :,.._.�:�... <br />