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, ��" t'S �S <br /> r <br /> �� PERMIT APPLICATION j <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 8 AM TO 4 PM �� ��,", v � � ��� � d`.' <br /> � SITE ADDRESS PARCEL TAX I.D.# PERMIT k <br /> � ..3...� ��� ;�.;� ;���: ri<<. �3�� �� .r�t � ��n�tie�.� 6 oa C� a <br /> LEGAL LOT NO. BLOCK TRAC � <br /> DESC. L P�' A Y{o, c-L�p cI � <br /> OWNER ADDRESS CITYIZIP � PHONE <br /> ��jl�l <br /> M' �\ 1� ,' �: ,-�• , �i� ) Lu/i.�� � �r2-i �� .f+r-Z '• �- r �"f Z.J: �_ ��'_� Z�:. lyl � ��j:, <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Lv^��e Z ��C���� F�'��� `izS-7�:�uoZz b' <br /> CONTRACTOR AD�RESS CIN21P PHONE <br /> Nc�}huz i} 1-�c;,.�ll�.j Il�o Jv.: 1t� SY /��2n�0� �585� � `f1S•2S�-US�'G <br /> I CONTR.LICENSE# <br /> I Nu^�1rtW�iZ�� jr_ <br /> ��, USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> w �� i� � � ��` Electric _Gas_Olher 1 1 , l�V V <br /> WORK DESCRIPTION <br /> y�$�c,�� S`t�t:jf'�v2 r�_\\�[ � C<.l'..k �n W:.I2 �^ O.: j L <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas pioing <br /> Shower Water heater <br /> Kitchen sink&disposa� _ Gas tireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> - Sink(service/badmop/etc.) _ Exhaust fan <br /> Backilow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> � Drinking Founlain _ Boiler <br /> 'I, _ Floor drain = Refric�eration <br /> Q Grease trap Woodstove <br /> �� Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify'hat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> �� construction.7 at 1 am authorized by the owner of this property to perfortn the work for which application is made and I wmply with the <br /> I State Contracto La .27 RCW and 296200 WAC. <br /> i, �. L i J-L � -� -7 <br /> L <br /> Signatur��6 Own rlGontract /Authorized Agent —Date <br /> ' � -�- - -- (2 <br /> : <br />