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t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,'dVA 98201 <br /> 425-257-8810- FAX 425-257-8857-wvm.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C(� �Qp ' O(� <br /> SITEADpRESS GG1wp Flve�+v� PA2�� PARCELTAI(I.D.K P MITB <br /> i9oo GRnNo AvtN�� C�t,z�r-r� �✓a �J�� '/� <br /> ygLc 1 <br /> LEGA LOTNO, BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> � rY of E�E2cTr pq2Ks bo� [. MUL'ILTEC (j�v�e�n2D ¢ZS-ZS� -$ joo <br /> '�e�2�;�TII.�J Q�;Q/I�tTMEtir EVL�LtTT�_ WJ� ���ZCj-L�L'U <br /> TENANTNAME I CONTACTFORPERMIT PHONE -- <br /> c��r-r� oF �:Jt�LCTT P�a2Ka �-{�N2Y �tl2of�t2 �ZS- z5�f x 3 �Z-� <br /> $ Re�ntn-r�o�-+ O�PnnTM��r <br /> CONTRACTOR ADDRESS CITYIZIP PHONE � <br /> �7�131� A( re,t �'cwr,tarr (ji� �C>jl1"1C- <br /> CONTR.LICENSE/ �i h �,V �L�I <br /> ��1W1'.�'L �c.Yt-i �I1L <br /> USE OF BUILD�I7NG I — HEAT SOURCE i.///� CONTRACT PRICE OF WORK <br /> C hT)� I'n21� Elednc Gas Other 32�i D00 CC-Snrhn rt u) <br /> WORKDESCRIPTION rJ�2K RENOvpT/c�,� - NLw SIOtwA�KS� Pc.nzns� �o�v1aOS� <br /> �i�i.Ir�r,G � wcrrl IINOEIL�jM1U�N�� C���Tititn�� PARk S�C�n�S, LAn.USC��°�+.G <br /> /1�U 26�cMrE�� �EatNc S fl^� �� PiCn+ic � TAIiLiS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling units <br /> Bathtub _ Forcedairsystems <br /> Lavatory(wash basin) _ Gas pipin9 <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer � _ Clothes dryer N //� <br /> Laundry lray N /,a _ Range hood <br /> Sink(serviceNadmoplelc j _ Ezhausl fan <br /> Backllow prevenler _ Heal pump <br /> Unnal Unit heater <br /> _ Orinking fountain Boiler <br /> Floor drain Retngera�ion <br /> Grease trep _ Woalstove <br /> Roo(drains Other <br /> Olhcr <br /> CITY OP EVERETT IOCAL SALES TIUC COOE IS J705 <br /> 1 hereby centify that i have read and examined this application and know the same to be lrue and coned. All provisions of laws and <br /> ordinaces governing this type of w�rk will be complied vnth whether specified herein or not.The granting of a pertnit does not presume <br /> to give authonty to violate or cancal the provision oF any other state or local law regulating construdion or the peAortnance of <br /> consiruclion.That I am authori�ad by the owner of this property to perform the work tor which application is made and I compty with the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> c�,i_._._. � ��n-iL�-r,Ci_ ( - � 1- O 7 <br /> Signature of nedContracro:lAuthonzed Agent Date <br />