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�— _— --, <br /> PcRMIT APPLICATI�,N <br /> CiTY !�F EVERETT PERMkT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA�8201 <br /> 425-257-8810— FAX 425-257-8857-�Nnvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 Aht TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �z-� z � � 3� L/-�C-� ��o��c�o ��ao � o� l' �0�'22 <br /> LEGAL LOT NO. FSLOCK TRACT OR SUDDIVISION# / �L{jS\I <br /> oesc. ��fl�l3� PLi�C�_.. i . c� <br /> OWNER ADDRESS CITYlZIP PHONE l{ Z� •'ZS�-) /S <br /> �/��/Y l.� /JI<�J//7�L-J LL.L � z���/J �^7�V�i�Lf7h��l i'7U��% / V�I�Itn�� W � <br /> TENANTNAME CONT.4CTFORPERMIT PH� Ln(��L���L Z� <br /> ✓/ �= U� ��I=I�IOL C-MAIL <br /> CONTRACTOR / .���n� �_ �7Qp��l�' �ADDRE� ��/ ` A /1 CITY2IP PHONE �9C6 ' 6�� GZ � <br /> N z2/Z� �. rt.�-�l� aCF L � <br /> i.v�eri r��� yF�zo � <br /> CONTR.LICENSE# 1 (JO Z Z I�J �l(C���L��'D /7 UfC_ /= UICM1 ���(YQ, /C.IL� <br /> U:3I [c ?�7c/- S <br /> USE OF BUILDING HEi.T SOURCE CONTRACT PRICE OF WORK <br /> / / .� <br /> _Eiectric J�Gas_Other �� �Q (� , � <br /> WORf< DESCRIPTION <br /> _ �/C�__�Z�--- � <br /> PLUMBING MECHANICAL <br /> NO. �fYPE OF FI%TUR[OR ITEIv1 N0. TYPE OF FIXTURE OR ITEM � <br /> Toilet AiC- air handling units <br /> �_ BathWb � Forced air syslems I <br /> Lavatory(wash basin) �— Gas pipiny � <br /> � Shower W�terheater <br /> � Kilchen sink 8 disposal � Gas fireplace <br /> � Dishwasher �, Gas range <br /> J Clolhes washcr �_ Clothes dryer <br /> �I �_ Waler healer Rango hood <br />� I Sink(service/badmop/elc.) � Exhausl fan <br /> � IZ Backtlow preventer _ Heal pump <br /> Urinal Unil heater <br /> ' Drinking Founlain _ Boiler <br /> Floor drain Retric�eralion <br /> Grcase tra��� _ Woodstove <br /> Roo(drains Other <br /> Othcr _ — <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS J705 <br /> I hereby cerility lhat I have read and erainined lhis applicalion and know tlie same lo be lrue and correcL All provisions of laws and I <br /> Iordinaces�overning Ihis type of work will he complied with v,�hether speci(ied hemin or not The granlin9 ot a permil does not presume <br /> lo give aulho!ity lo wolale or cancel t �provision of any olher state or local law rcgWaling construction or the performance o( <br /> conslruc �on.That I am a��lhorized b lhe ner of this property lo ptdorm�he Hork tor�vhich appli;:ation is made and I comply wilh the <br /> Slato nlr tors Law 18.'-7 fjCW� id 2 6�00 WAC. <br /> � CC�J i�� �1 -ZS O c <br /> � Signature o(Owner/ ontraclodAulhorized Agenl Date <br /> !/1 <br /> ---. — .— 1 <br />