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� t <br /> � � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Cr � �p_c7� <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P y� �U `I �� <br /> SITE ADDRESS PARCEL TAX I.D.A ,RERMIT f /J <br /> J <br /> 1L11�- ��IJ,�� ,�� 41�;� �, ;, . C�l ' .�ct,��,���,� ���v '1G"] �� �� ��0lf <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 5��_. ��H i:'f 'i��� Nt ,�y tif' :.)�tc�{ � i-wv .agrv� KC�� 3L� <br /> OWNER ADDRESS CITV/LP PHONE <br /> ,:t l �I_ n�.ovd� tl?S''/IS= 1:bA <br /> /? ,�r�. P, . �• 'r • _ ,��.I`I t ,, :liec S{•d�,..y �C- � Lyrbi N7 <br /> / <br /> TENANT NAME CONTACT FOR PERMIT 'PHONE <br /> ; (_� �i � '. IZCi�n�cir'1 • �aGC - 7b�(u �-(.��775 <br /> CONTRACTOR S:^���e�:r c•,5 C�_.,lc.(� ADDRESS CITY2IP PHONE <br /> CONTR.LICENSEN � (�ZI V ���°�l��i I)'i <br /> USE OF BUIIDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> '� �- !� Eledric �Gas Other Y�' I '-JU� C:Gv <br /> WORK DESCRIPTION , , ;- �` <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> ' Toilet A/C-air handling units <br /> � Bathtub I Force�air systems <br /> Lavatory (wash basin) _� Gas piping <br /> � Shower i Water heater <br /> f� Kitchen sink 8 disposal � Gas fireplace <br /> � Dishwasher ,� Gasrange <br /> I � Clothes washer _ Clothes Aryer <br /> � Laundry tray i Range hooc <br /> Sink(service/badmop/etc.) ! Exhaust fan <br /> � BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby centity that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wiUi whether specified herein or not.The granting oi a permit dces not presume <br /> to give authority ro violate or cancel the provision of any other state or local law regulating construGion or the perfortnance of <br /> construction. That I am authorized by the owner of this property to pertorm the work for wliich appiication is made and I comply with the <br /> State Contraclor�Law 1827 RCW and 296200 WAC. <br /> ����� � / L'i-''/ �>> <br /> Signature of OwnerlContractoUAuthonzed Agent ' � Date � <br /> L <br />