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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ? "� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 //�I�f�� C.�f� <br /> 425-257-8810—FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS FARCEL TAX I.D.N PERMIT k�'�i� - <br /> , �.1� 1:;r,tl ������ ������� �� o� �a3 3� t,��/1��% <br /> LEGAI LOTNO. BLOCK nTRACT I <br /> OESC. (.E,�^�. � IIC,I'I�.� S � P�l�/� ` � �-Z I4 <br /> OWNER ADDRESS CIN21P PHONE <br /> L�e G�.,nn�.�- aa�s ,o����;�� c���c �a,�t�ny e�� r�+4 tis�; y�sxi � , <br /> TENANT NAME CONiACT FOR PERMI7 PHO E <br /> �� �, -�c� � K�; Con�,x; s ���, y�3 � �99 <br /> CONTRACTOR 11,, ADDRESS CITY2IP PHONE <br /> �.�,� . � U <br /> coHrR.uceys�� � _ � �,��)I ��S�/S� l,l;l(a..��(l1� (Ln�T:r��� 9`�;`S� � <br /> � ; � `�vb � /�� ��! <br /> USE OF DUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> — — 'rJf�'/� 'f <br /> ElecMc _Gas Other �S � OQ� <br /> WORK UESCRIPTION �U C�X�� I �CC���`��, `�-G �" -ICk 141 t��^ic,.Qil AS O/� �'�.c �����S�':'� <br /> i��a�c�ole loc;til�� � (�� �I�� AI,1r��SS {I�j,.x' . � �r� - FASc ��,��� � C�y� -����.,� <br /> �� 1���� � � �i:o�.Z���d o ,� S1 ,-e��S P�,�•,1 (r:�nD� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping l?C1� <br /> Shower Water heater � �x�"�i� <br /> _ Kitchen sink 8 disposal _ Gas freplace ���� <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry trey Range hood . <br /> _ Sink(servicelbar/mop/etc.) Exhaust fan <br /> _ Backflowpreventer Heatpump ���� � <br /> _ Unnal Unitheater %� � � y � <br /> _ D�nking Fountain _ Boiler �' <br /> __ Floordrain Refrigeration�� � <br /> _ Grease trap Woodslove` � <br /> Roof drains Other <br /> Other —_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritify 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 lhis type of work will be complied with whether specified herein or not.The granting o(a permit does not presume <br /> to give authonty to violate or wncel the provision of any other state or Iocai law regulating construclion ar the perfortnance of <br /> construction.That I am authorized by the owner o(Ihis property to perform the work for which application is made and I comply with the <br /> Slate Contractor&�w f8.27 RCW and 296.200 WAC. <br /> ✓//� �� ---✓�' I.� �• �-� <br /> Sign�ie of OwnedContr r/ytho zed Agent Date 7�a <br />