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PE�MIT APPLICATION <br /> CITY OF EVERET7' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEFif_TT, WA 9F5201 <br /> 425-257-8810— FAX 425-257-8857—v✓�vw.evereltwa.org <br /> APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT�jt <br /> � �' � <br /> 4%L I :.. I�C"rlw�J:;`, l�'�'�•"-i V't._ -� � '�;�LI(o 'G '��'Dll ' C���� - <br /> LEGl�. LOT NO. BLOCK TRACT OR SUBDIVISlON p <br /> DF'SC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��'j �,�� `, (�lr ,��'; � 1, << r , �: I�-��,,����,-,,;� i��-ive �� "' �u��lk�l vv�l � a�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE �(,��y� 7,aq �- I b SS <br /> I"���� � '� � / � � A � � <br /> 1�� 7�i ! Q GL���tiV1�i" l,�-1,U�17 �;n�ni� Z'r_�rif s'«i�rn'ri I� .c;,r�i <br /> CONTRAC�-�: ,tir,.�� ,f- ` L�t;�n'vr A6 ESS C T /ZIP �PHONEC �_ <br /> _'�"�7 tf_cirrl'__ Yil!1���; I �.f7Ll N��3y cfcl .'#�-C_ (U�..� 74> �SS.-�� <br /> CONTR.LICENSE p � L���"1��� ✓�' '1 `�h�"i ; <br /> �TI:I^/NC�F-ZJ�1`� LT ( F{�- �i�� '1 <br /> USE OF BUILDING HEA'�SOURCE — IV CN� CONTRACT PRICE OF WORK <br /> Electric _Gas_Other � � <br /> �C� � � l-" = — ��' II � '-IC.� C� i7 ,(c <br /> WORK DESCRIPTION U�U � -1 - <br /> � � c�.��t c�t��� �vS , -}.Cf i��L� C'�'� �� � �C: <br /> ;�� „�'li_,�I''l�_� jl'" I" I;� i; �j �; C . �, [�F-oV�� �t-.�7� �� � ?i lC ���1 �) <br /> 1� �C���•'� �.'�/ % �'�� ��i' �� � � L���/��, � �JJ� � ���i12�,- �j,� A!_Ui �L.Ylli-�� <br /> PI_UMBING MECHANICAL <br /> NO. I TYPE OF FIXTIIRE OR ITE1A NO. TYPE OF FI%TURt OR ITEM <br /> Toiiet NC-air handling uni�s <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower , ./ _ Water heater <br /> _ Kilchen sink&disposal 1 j Gas tireplace n <br /> D��shwasher _ Gas range I,\ <br /> _ Clolhes washer / _ Clothes dryer � r <br /> Water hea�er _ Rar.ge hood <br /> S�rk(,service/bad e .) __ Ezhausl fan <br /> _ Backflow prevente __ Heal pump <br /> Urinal Unii heater <br /> __ Drinking Fountayi Boiler <br /> Floor drain / Refrigera�io <br /> Grease tr � __ Woodalo <br /> Roof d ins __ Olher _ <br /> _ Oth _ _ -- -� — <br /> — , - <br /> CIN OF EVERETT LOCAL SAI.ES TA%CODE IS 3105 <br /> I I hereby ceritily ihat I have read and examined thls appllcation and know the same to be Irue and cnrrecl. All provisions of laws and <br /> ordinaces goveming Ihis rype ot wnrk wili be complieo wilh whe�her specified herein or not.The granting of a permit does nol presume <br /> to give�uth iry to violate or cancel Ihe erovision of any other state or local law regula�ing cons�ruclion or Ihe performance of <br /> cqnslruction. at I am authorized by,tlte)bwner of this pmperty to perlorm Ihe work for which application is made and I comply with�he <br /> Stale Comra Law 1�.27 dCW.�nd�96.20 AC. � <br /> c ,'"L �i , I / ,�[, G. <br /> o � <br /> I Slgfiature of qwner� an rac or/Autnorized Agent ate / ' <br /> I <br /> �Z <br /> ' --------- — -- ----- - <br />