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t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, bVA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> Wsou nnz.�r�l� c�r:_�c P►c,, -� a $puU�. 0030� 3 ��v - ) � <br /> ✓crtN- w(> `1 �� 3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. �C � 'a G� 5`".e��,✓c (Lk.co��� �i R a oyo�S vv i ,h ✓o� I <br /> OWNER ADDRESS CITYIZIP PHONE <br /> C� CL� chG.rc� E�i ,s N �a <br /> TENANT NAME CONTACT FOR1 P1ERMIT PHONE <br /> � 7� �'e.l�o_ r�0�/�(6U'C.. �i�.l� � ��e5� —�(Svl7 <br /> ..l <br /> GONTRACTOR ADDRESS CITYIZIP PHONE <br /> Mo.c.C�o r.o.�d iM,\lx,r 1�71 l �c.�-�-a�t- �-� s I,.� �d�) <br /> i�lc,(.vn� 7i��j-�l a-7,� <br /> CONTR.LICENSE# I jl/J7 ��R`�(U�. <br /> M I'�C O D F 5 �1S''^ 12, <br /> USE OF UIL� ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> `�' ' � �0 �J11, � <br /> I �Electric �Gas Olher 1 3 <br /> WORK DESCRIPTION <br /> �cld1 'I n-e�,., S- to.� q C. �vvF-�o� (�a-ef.�+� �t,.:�+ , G d d 3 <br /> -C�l �"\�QyN.i.�.� �P�►'L� � n�l��i C�\k�u.a e.r/ �� �I1.1'o �•�c� e�•�C�' w6��C <br /> g.c.r l c�-.�� - tvi i s c � M i n <br /> PLUMBING MECHANICAL <br /> NO: TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi � A/C—air handling units <br /> Ba1hW Forced air syslems <br /> Lavalory( h basin) Gas piping <br /> Shower Waler heater <br /> ICilchen sink&dis sal Gas Greplxe <br /> Dishwasher Gasrangc <br /> Clothes washer Clothes dryer <br /> Laundry tray Rangc hood <br /> Sink(service/bar/mop/elc.) �_ Exhaust fan <br /> BackOow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain 8oiler <br /> Floor drain Refrigeration <br /> _ Grease lrap _ Woodstove , <br /> _ Roo(drains � _ Olher C1.0 ! in� <br /> Olher U <br /> CITY OF EVERETT LOCAI.SALES TAX CODE IS 3105 <br /> �hereby ceritify that I have read and axamined this application and know the same to be irue and correct. All provisions of laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whether specifed herein or noL The granting of a permil does not presume <br /> to give aulhority to violate or cancel Ihe provision o(any other state or local law regutaling construclion or ihe pedormance o( <br /> conslruclion.Thal I am authorized by�he owner of ihis property to perform the work for which application is made and I comply wilh the <br /> Sta crCdntract rs Law 18.27 RCW�00� <br /> � �� I - u � <br /> Si alu wnedCoNractodAulhorize�7jgent Date I/� <br />