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-- - -t ' <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 B AM TO 4 PM (o_ap �-��- <br /> PARCEL TAX I.D.M PERMIT# <br /> SITE ADDRESS �I_� <br /> �G' � � ��„�i. k=.,L\c\ 1��:,.r <br /> 053 �DOoJIS�� � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. `. :`,\ca7-� S..�vAav...�w-r+ -6-� t'i - �'=�8 <br /> O'NNER <br /> ADDRESS CITY2IP PHONE <br /> .�i ,. ���R l� lla<�a �? � � �� � .L�-� (1c;'�1 - �y+y�� `>r l��1�,�11 �l�� i? `-i'�5 i4'i'I �b' <br /> I CONTACT FOR PERMIT PHONE <br /> TENANT NAME `�"�� "q`I''� ���� <br /> L.I N L c' �>'>I� E•MAIL <br /> DDRES C IZI PH <br /> T\4\2 �'L1T'-� .) �I 1r7�\ll. 11l "i;9.-3"��1Ut' ��F 17..t����� �J..�('� L�.1J �`� 3 1 ��j <br /> I�,. 1 �- � <<<�:.�T <br /> CONTR.IICENSE# <br /> USE OF BUILDING <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> ...�i 11.111 r.'-lv-.�..: . �',�Y��l.,r.� — — � � `�, GCX].cC. <br /> � � Eiedric Gas ✓Olher � <br /> WORK DESCRIPTION p"` <br /> � 1�,,,� c' a��.>>c4.t�bi.-.'' .•� _J�-,`� .kD.V�na.t.., J�V-lcl....�r- <br /> v <br /> . � <br />� PL MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> A/C-air handling units <br /> 3_ Toilel j Forced air systems <br /> � QatMub � Gas piping <br /> � Lavalory(wash basin) _�_ Water heater <br /> t Shower �_ Gas firepiace <br /> _(_ Kitchen sink 8 disposal �_ Gas range <br /> t Dishwasher i Clothes dryer <br /> I Clc�hes washer � Range hood ! ����C� <br /> �_ Sink(serviceNar/mop/elc.) �,,,.r��Fy �o„�i �- Healpu'mp <br /> Dackflow preventer Unil heater <br /> Urinal Boiler <br /> Drinking Fountain — Refrigeration <br /> Floor drain Woodstove <br /> Grease lrap �— Other — <br /> Roo(drains — <br /> Oiher — <br /> CI1Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceAify that I have read and examined this applicalion and know the same to be Irue and correct. Alf provisions of laws and I <br /> ordinances governin9 ihis type of work will be complied with whether specified herein or noL The granling of a permit does not presume <br /> to give authoriry to violate or cancel the provision oi any other state or local law regulating construdion or the pedormance of <br /> construdion.l"hal I am authorized by the owner of lhis property to periorm the work tor which application is made and I comply with the <br /> State Contrectors Law 1827 RCW and 296200 WAC. <br /> �� 1",L� <28� lo <br /> ' v� "� — Date f/�7 <br /> SignaWre (OwnedCoNractodA thorized Agenl � <br />