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�- <br /> P�KMIT APPLICATIO�1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STP.EET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT N <br /> I`�,o5� e�i, ��v : �d-3� 1 -���-- o� - oo ��oo3 -a C/ <br /> LEGA LOTNO. BLOCK TgACT <br /> DESC. � ( �L U� I f'l.�A r �� �L <br /> N R . 1 I ADDRESS CITY2IP , .�HON <br /> G✓ t� F-i�' ��'.vl � K-�U �'Lj L Ff- (o'e'o� <br /> a c�lvro � VS I.LL P�\3�x IZO�� ,��a W1�1 � $2�L <br /> iENANT NAME CONTACT FOR PERMIT ( E <br /> VVl-�r�t- L{�E Lo�rz�s --�r�-►�� �z�►�t1K— 7��'�►� • z� <br /> Ly��s s �-Zs)Zs�-6�o� <br /> CON CTOR ADDRESS CITY2IP PHONE <br /> OW��L��. <br /> CONTR.LICENSE N <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> �m� ` ���., 1 I �Electric _Gas_Olher ��0� � � �sJO <br /> WORK DESCRIPTION <br /> lv��-�� �'���z � Ln,�-'-� ����� �� �--ne�Y1�s .�-, �,� j , n <br /> -V�CvV� �Se,� 1ti��-l��c�n.--��Cd,v�., L k?Z�WaN/Ey l.l Sl�I.T�OC FX��� t <br /> V G I -�'lV� LL"L- � �ri^ Y\+� Q � <br /> LUM NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ 'foilet r x ,�`, `�� _ A/C—air handling units <br /> BaTub r _F_o,�rced air sy s�tems <br /> _ Lavalory(wash basin) _ as pip� (ng �K �S�1 N'i <br /> _ Shower Water heater <br /> itcl�hen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/har/mo�/etc.) Exhaust tan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heatar <br /> riC�Tn u g Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease trep Woodstova <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same lo be lrue and corcecl. All provisfons of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified horein or nol.The granUng oi a permit does nol presume <br /> to gi��o aulhority to violate or cancel Ihe provision oi any olher stale or local law regulatlng conshuctlon or the performance of <br /> construction.That I am aulhorized by the owner of lhis property to per(ortn the work for which application fs made and I comply with the <br /> S le ntractors L�aW 1$.27 RCW�7Rd 296.200 WAC. <br /> � .t�v � !-�2'-12'v� `7t�V <br /> � I �.�� . v � -�c�� ... '�( �.� o,� <br /> Si e of Ownerf�o or/Aulhorized Agent Da <br /> � �� �� � <br />