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i —� —� -- <br /> I P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX�.D.il PF„�tfdllT# <br /> 15oc� � �i�i.��� ��Y ST � r <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CIiY21P PHONE <br /> � ����:�����"��' � <br /> i ��i,:�,i� I�r�(�:-�-1;c� � �=�► �� ��'AC ' '<� �-n�� l�l,l� LL'/� 9��_3. ".` <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 1'1aUe��Ck. lr:,�_��1.�z,ou� N�A�a-F�� �l�.�F '`�"Z.S-`�13��5(�Z <br /> CONTRACTOR ADORESS CITYIZIP PHONE <br /> ��c_�e�, �V�;tii 7�G0 N�,''d e.��.�� � , f�1�YL4�1, 1,�'A- 1�.�s -�7��n - � <br /> CONTR.LICENSE# ��G'� �� �,y��j <br /> C. O <br /> USE OF BUILDING I f1EAT SOURCE GONTRACT PRICE OF WORK <br /> i " �/� <br /> ���. '� ; �, ��1 �Electnc __Gas_Other 1Q��-� �"�"' <br /> � <br /> WORK DESCRIPTION <br /> ��L��II � il>r'��-L/jl-IU/J <br /> � PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/har/mop/etc.) Exhaust fan <br /> BackOow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> _ Floor drain Retriyoration � <br /> Grease trap Woodstove <br /> j __ Roof drains � Other s iq�n _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COGE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know lhe samo to be We and correct. All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied wilh whelher specified herein or not.The granting o�a permit does not presume <br /> to give authonry to violale or cancel lhe provision of any olher stale or local law regula6ng consWclion or ihe pedormanco of <br /> construclion.Thal I am authon d by lhe owner of this property to perfortn�he work tor which 2pplication is made and I comply with tha <br /> State C nU cfor�Law 18�2 RC nd 296.200 WAC. <br /> '_ -- .J � , �-�-'Z�C'� ( <br /> Signatur o OwnedCon�rector u onZe�P,IlI Date �j \ <br /> I ) <br />