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� <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 /> AF'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRE55 PARCEL TAX I.D.# PERI�IT# <br /> noc niF" Iiu, - '�C � W Z -'�'o 02oo�,c� soo � �/� .� �, <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �L�= ;"' AC - <br /> OWNER AUDRESS CITYZP PMONE�`N ��_;,��v� <br /> /1'l�'�'�`�C-G_ �l�'-EG� �t�;� (JJJif/EIZS/)z� ST, <br /> yLY (�%N��c S L1—�_ Sl�� ?�J�C� �C.��YI�'�l,'�. l2Gcc,lC�I�t7 . c�l7C�^� <br /> TENANT NAME CONTACT FOR PERMIT �� PHONE <br /> �-},�J�Lf7 chI'(L1 SZN "�E�} <br /> hij�t ,E�> T�c'f)13Ic-F1� 5CF'l!1 �o�Ar�4` Ih,:lu�71 lkf�Cha�lE`�� (�IOG��nS.�siS'�i <br /> CONTRACTOR ADDRE55 CITYZP PHONE <br /> S�A c-cl'��L+��ti.� i`�.� N ��r�4-r, .sr �����N� <br /> CONTR.LICENSE p <br /> �SC�/-� GO ��� ���5 `�`3�'�ni IC�, ��J7 �21`lI <br /> USE OF BUILDING p{�� c�� I HEAT SOURCE CONTRACT PRICE OF WORK <br /> W:-���c r��S��, _.� <br /> 6ti�rY��i� -t�f " '�� _EleIXnc �Gas_Other ' ��j)D/ L`�� .- <br /> WORK DESCRIPTION �`tr��� G.� ��5��(, p!r� ,��4`. �c.C�-S <br /> UFT"�r-5� Llli.14� f wt.� � Ct c�N�c�SL `�,i,i..� d- S�1c��E�z S <br /> �X/>i7.J G. �:���j f'�.,o�+�S l�r/�� /jE cJT/c. /Z`r� <br /> PLUMBING MECHANICAL <br /> N0. TYP[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 <br /> � Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> .Dishwasher Gasrange <br /> Clothes washer _ Clothes dryer <br /> _ Lau�dry tray _ Range hood <br /> Sink �ervice/badmop/etc.) _ Exhaust fan <br /> Backflo�+t preventer _ Heat pump <br /> Urinal � _ Unit healer <br /> _ Drinking FoLnlain Boiler <br /> Floor drain Refigeretion <br /> Grease trap _ Woodstove <br /> Ftooi drains Oiher` <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES SAX COOE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correci. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> lo give authonty lo violate or cancel the provision of any other state or local law regulating conslruIXion or the performance of <br /> conshuction.That I am authorized by the owner of this oroperty to periorrr the vrork for which application is made and I comply with the <br /> State C �tradors Law 18.27 RCW and 296200 WAC. <br /> ��lfc..--�'�/�' / / �[��.r,(,L4�._-,.. '���� <br /> ignature o wnev ntractorlAuthonzed Aaent �� ate' � <br /> __- �z_ <br />