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PEhcMIT APPLICATIO[� <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> _ 425-25i-8810 - FAX 425-257-8857 -www.evereltwa.org � <br /> / - APPLICATIOMS ARE ACCEPTED FROM 8 AM TO 4 PM �''J`�F,`I -� <br /> p , <br /> SITE ACDRESS / �' � i � PARCEL TAX I.O.# �ERMIT# C <br /> �-�.� H�y� r.y. C��nc.�cT Oc�h-'�-7v3�14�D, �vi: �' C�!� // ' Oz� <br /> LEGAL LO'f NC. BLOCK TRACT <br /> DESC. 7 /�� (1 (}T �UG�'`T �}�1�S1�:N 1 <br /> � � '�7- -J ! U 1 L (��r � <br /> OWNER ADDRESS CITY(ZIP PHONE <br /> ��En�����e l�C- 7b�q- z�i4-T,. �r n�� /},z���.,�-�� GY�zz� (7Nc) 90� ?��� � <br /> TENPNT NAME CONTACT FOR PERMIT PHONE <br /> � <br /> JJu�<�� En> �` N��7�S Zo6- �-�:q - � �3� <br /> CONTRACTOR ��[Oti� TNC , ADDRESS c�rrrztN PHONE <br /> ��o U. �J'�L'�-LIn� 2, Gt1+�\A'�V <br /> A D scAv� �z5-`G�� -153Z <br /> CONTR.LICENSE N"�I�4(�0=�'q17(�{� 1' <br /> ��ZY��Z <br /> USE OF BU14DING / HEAT SOURCE CONTRACT PRICE OF WORK <br /> 94 U '�t4 I Ll ' �nl �/J <br /> ��'�-���� �.j. �� � / ����� / _E�eclric X Gas_Other ���� (��C)C] �� <br /> WORKDESCRIPTION C,�-1�/G.L �;'{y�t.Tu� �"p (JW��i'� �jl'Qc�Ci-'u�'-+�- 3u`W UF Z <br /> ��,ir�'LCYCS Iti%C�uT�tnlCn ' CcPiJc.ti7 wck-�� uT����l� Fk�.Cw('S. ��llv>.4310ni � ��w��r� 1R''��''riMn� <br /> {L1CttFA�V'�CfH- PLuwi�1/�(�� E'L�C�"�1CA"L � �Vil�v�-T�JC, IUS���F� •���TS�7t= �in��Sli � LRvDsC+4�t <br /> /4N�> fM3/ �i+�i7' Lt1�e21��?✓ (tS ID �GWD��1�v nv�? �=y�.� WS�c,'�'ON� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF fIXTURE OR ITEM NO. TYPE CF FIXTUR[OR ITEM <br /> � � � Toilet �' � � A/C-airhandling unils <br /> •'� BalhWb a Forced air syslems <br /> - I<- Lavalory(wash basin) � (p� Gas piping <br /> � �5 Shower � �,L Water healer <br /> .��� Kilchen sink&disposal ��� Gas fireplace / <br /> �.-� Dishwasher Gas range <br /> � Clolhes washer .�� Clothes dryer <br /> � Watcr heater �� Range hood <br /> Sink(servicz/bar/mopletc.) ij_ Exhausl fan /�// <br /> � _ Backflow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain � Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains � Other C;lc� Z-Av�r <br /> � � Olher_ � �,' � � <br /> — I <br /> � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 � <br /> I ' I <br /> � I hereby ceritify lhat I have read and eaamined Ihis application and kno�v�he same lo be true and correcL All provisions o(laws and � <br /> ordinaces c�ocerning Ihis lype ot work will be complied wilh whelher specifed herein ur noL The granting of a permil does not presume � <br /> to give aulhority lo violale or cancel the provision of any other state or local la�v regulaling consWction or the perto«nance of <br /> construclion. That I am aul rized 6y the owner of this property to perform the work(or which applicatiun is made and I comply with the <br /> State Cont ors Law 7 RCW and 296.200 WAC. <br /> .._'� � _ 2o U <br /> � Signal re o(Owner/ ontractodAuthorized Agent Dale <br /> I �� <br /> ` - ---- - --- ---- - ._ __.--------- — — --- - 1 <br />