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i _ � <br /> f � <br /> PERMIT APPLICATION ' <br /> g --�o_a5 <br /> CiTY OF E�lERETT PERMIT SERVICE.S <br /> 3200 CEDAR STRF_ET, EVERETT, WA 98201 <br /> 425-257-8810–FAX 425-257-86�7–v�nvw•everettwa.org <br /> APPIICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> C/,'!.-'G'S�/7i�.v PARCEL TAX I.D.# I PERMIT# � r � j <br /> SITE ADDRESS !���G +�,/1 ���:'! '�� . <br /> � -<<nJ � + <br /> c� R�n � /i'� ,� . Ll-..,. �% A ' <br /> � •, i�7�/ - / - <br /> L[GAL LOTNO. BLOCK TRACT ' <br /> DESC. pHONE ' <br /> -' U� ADDRESS ��TM21P - <br /> OWHERCNiJS F/7!/"!/ //Y/.iYNic��-'• <br /> �d5�;a�,v�vi�.-C-rEl�1ri'Nn .;�i� F <br /> �;•� ' �'f-/jfld.u!-> lc//9 � <br /> �''`�.)l--- /} �yl 7E C/'i PHONE � <br /> •—�'� CONTACT FOR PERMIT <br /> TENANT NAME � <br /> c,>c�a5"r_'rJ�"" c-oi-'Pa,C.rlrs.�% �. � '� 73�'c• i <br /> � �o�� !/Jr`i�i�n�� 5r�, � , 94� <br /> � "^V /Ni�✓`i�Y /3.`-1'/� c i/�i�C� I� � CITY2IP PHONE <br /> CONTRACTOR ALIDRESS � <br /> Cr�" 5' /r/>1%�N`. "0� i��'c_ .;�O Cyti7" f'�i/�� S� /`TG,c/F.'oE <br /> CONTR.LICENSE# �J�17� �(./� '"�9y'-7j��G <br /> / �L� 7 / .? <br /> G- S ��/ -A l g—` I �HpqT SOURC� I CONTRACT PRICE OF WORK <br /> USE OF BUILDING <br /> Eiectric:�Gas_Other 2 9 �-G(, , �' cJ <br /> C c� r�i`IC-�-'c��9�- — — <br /> WORK DESCRIPTION �� --'�J� � ( ,Z� ����� ��''�� �'-������ ���}��< S <br /> /.�- S� <br /> � ?� U/✓:!l {�EA-;'�i`=s' <br /> �5 J F-✓J�'L°cIST F-Aic,� <br /> /1L�- /7�.Cu <br /> � Ja D�FFv56,�= 5 Cr'��-LES � <br /> PLUMBWG MECHANICAL <br /> WO. <br /> TYPE OF FIXTURE OR ITEM ��0. TYPE OF FI%7URE OR ITEM <br /> :�-� AlC-air handling units <br /> Toilet Force�air systems <br /> Bathtub � Gas piping <br /> Lavarory(wash basin) Water healer <br /> Shower V Gas firepiace <br /> Kitchen sink&disposal Gas range <br /> Dishwasher Cblhes dryer <br /> Clotnes washer Range hood <br /> Laundry tra/ S [xhaust fan <br /> Sink(service/bar/mopletc.) He2t oump <br /> Backflow preventer � Unit heater <br /> Urinal Boiler <br /> Drinking Fountain Refrigeraticn <br /> Floor drain Woodstove <br /> Grease lrap Other <br /> Roof drains — <br /> Olher _ — <br /> I <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I havc read and examined lhis application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming lhis rype of work k�ill be complied wilh whether speciled herein or noL The granting of a permit does not presume <br /> to give au�hority to violate or cancel the provision cf any other state or local law regulating construclion or the performance of <br /> construction. That I am authorized by the owner uf;his property to perfortn the work for which application is made and I comply wilh the <br /> State Conlractors Law 1827 RCW and 296200 V'lAC. , <br /> --� � ;��i „�z :: .,- , ��'���' S n �Z <br /> c, ale <br /> 5ignature of Owner/ContractodA thonzed Ag t . ��� _/`� <br /> ` 7 <br /> —_—_- -- <br />