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i <br /> � � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 <br /> SITE ADDRESS PARCEL TAl(I.D.N PERMIT A <br /> •�.c � �- � - AL,� t=t- 1�� cc�- ��,���o �7oa o3- <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �c' � C�. Cl 1 � <br /> ONMER ADDRESS CITYIZIP PHONE <br /> C e���iC ���ICtt< <�t�cu� a-le���t� 'nU@��-1?�5 ��'e!'e 1-} �-1��-3��.� -��aC <br /> TENANT NAME CONTACT FOR PERMIT PH01:8 <br /> �vr- rc��-1 �'��e ���� Pa�iY1(E.�-�C�IC. �G�c, 5�15�-�1ZOO <br /> CONTRACTOR ADD S CITY2IP PHONE <br /> I I(' r h�CulSi:n C-�� � •�;� I �„c?��i� I�I . Y z r� �-, l�1 i� ;�Olv !7 Z�� �1Z0(. <br /> CONTR.LICENSE t <br /> � 1�(��»�1 ` 1 Gl'`�17S <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eledric _Gas_Other � i D� p��� <br /> WORKDESCRIPTION ��_C����C_E-- "`-� OIUY\L�^ '��"LU 1'�1'j�lL ��. cc�lLL+�IflC�ll� l <br /> j�tic�v � d� �� c�� ( I) 3- C•or�-,��r�r1�,-�, � 1 S���K , l� ) l-Ic�� �cl. ���i'� K <br /> � d �3 Ti�c�� teCi- I�J-�.�n�� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> � Kitchen sink 8 disposal � �'- < <_�-����� ++��.•�,t� _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry trey Range hood <br /> � Sink(servicelbarlmop/etc.) Exhaust fan <br /> � Backllow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiier <br /> � Floordrain _ Refigeration <br /> Grease Irep Woodstove <br /> Roof drains Other <br /> � Other�Y.cl �rc , t 1�rC�i�� — <br /> CIN OF EVERETT LOCAL SALES TAI(CODE IS 5706 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specihed herein oi not.The granting of a pennit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law reguiating consWction or the pedortnance of <br /> construction.That I am authorizeA by the owner of this property ta pertortn the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> '�.' �tt `L_L� ;I-� ( �C1lL <br /> SignaWreofOwnedConlractor/AulhonzedAgenl Date <br /> �I <br />