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( <br /> PERMIT APPLICA�ION <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 R AM TO 4 PM <br /> SITE ADDRESS / y PARCEL TAX I.D.It PERMIT# <br /> �OL�� C9/�C<.^ ,C /71�2/^Gf 'c� D Z) UOI � D G — D � � <br /> LEGAL LOT NO. ��S� BLOCK TRACT OR SUBDIVISION p <br /> DESC. (� z .y ,Z, '�,'L� <br /> OWNER ADDRESS CITYIZIP PHONE ZS- f(�-2�') <br /> .S'TEI�i/HNIE /�L-7t�SfT� /OZ�I L•�/2�f-ND f}Z��• L—�2/67'�-=T%. �✓j`1 `1�zv/ <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> C NTRACTOR ADORESS CITYIZIP PHONE (,�= jy&"3Z� <br /> U13t-�f}NOLa".SON �'C�A/STi�'ut �icn.� /Z// �h' D/</l�E M[/K/LTG'Q Wf� <br /> CONTR.LICENSE p ����� /� /JG LI�I K I <br /> r�i� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (%/�%46G �'L'-71i1D0LZ ✓Eleclric _Gas_Other �� ,e�,5�7 <br /> WORK DESCRIPTION <br /> Ti�r� Oc�vni �-N,G �ee�[��r,�d exish:,5 ����s,�- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel AIC-.ir handling units <br /> BalhWb Forced air syslems <br /> Lavatory(wash basin) _ Gas pipmg <br /> Shower Water heater <br /> Kilchen sink 8 disposa� _ Gas 6replace <br /> Dishwasher Gas ranye <br /> _L Clothes washcr _L Clothes drycr <br /> Water healer Range hood <br /> Sink(service/badmopletc.) _ Exhausl fan <br /> Backllow preven�er _ Heat pump <br /> Urinal Unil hcater <br /> Drinking Founlain _ Boiler <br /> Floordrain Re(n9erahon <br /> Grease Irap _ Woodslove <br /> Roof drains 0111°� <br /> � Olher — — <br /> CITY OF EVERETT LOCAL SALES 7A%CODE IS J105 <br /> I hereby certdy that I have read and ezanuned this apphcalion and know the same to be trce and correct. All provisions of lavrs and <br /> ordinances c�overning lhis lype ol�vork will be complied�Nlh whr.lher specdied herein or noL The granling of a permil does not presume <br /> lo�ive authon y1 to viola�e or cancel the provision of.any/blher stale or local law re9ulating conslrucUon or Ihe performance ol <br /> construction. 11at I am aulhonzed by the owner o(ttys operry lo perlorm Ihe�wrk(or which appllcation is made and I comply with Ihe <br /> Slale Conl �s La�y 18.27 RCW v 93 00 <br /> ,C�. '%IG�C��� �:� �i� - z�- id <br /> Sig�ureol merlConlractorlAuthor¢ed ent Date '/ <br /> � �` <br />