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i <br />i <br />PERMIT APPLICATION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR Sl"REET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8657 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO J PM <br />SITE ADDRESS <br />5c 1�,� <br />LEG� LOTNO. BLOCK <br />DESC. <br />OWNER <br />L �[- PRvvE,ents <br />TENANTNAME <br />PARCEL 7AX I.D. # <br />TRAC7 OR SUBDIVISION p <br />// �cd /rluKic r�o <br />s-lo _ i� <br />PERMIT # <br />�'1 I 1 i l� C�- i0 <br />: �Iz� N�'r-�35, <br />CONTACTFORPERMIT PHONE / / <br />�%���-A/� /CX7/CIf� C�E-MAIL%%S"CC�I(C�% <br />CON7RACTOR nuoHess � u <br />D9�r' �tn�rrE Pcm�sG d-HT�, /�!r/�/ ���1C/-{�c'•l✓ L <br />CONTR. LICENSE p � <br />USE OF BUILDING <br />N`�D [-(2.5-775-G��fCo�{ <br />n ^J ^l <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleclric ,�Gas _ Other '� Jl ` Z�• Cv <br />WORKDESCRIPTION �'J{�CACE �X�S�N� UIL �/,'�j}"C� (,�'lT}'I f} I��1'lf �7`jS <br />j-�riz�✓AcC �; �� s'Mn2 [v�Ano�U� /�UN GAs P;Pi�J�. �o.r� N�cv <br />�,E-r�rL "Tz7 �'-�r�zNac�� il�<P�acE� /io7 ���t'�n rq,i1K� DP�'rE�z� �F /2,qrP�2 • <br />NO. I TYPE OF FIXTURE OR ITEM <br />TGilel <br />Oathlub <br />Lavatory (wash basin) <br />Showcr <br />Kitchen sink 8 disposal <br />Uishwisher <br />Cbthes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinkinn Founlain <br />Floor drain <br />Greasetmp <br />Roof drains <br />Olher_ _ <br />TYPE OF FI%TURE OR ITEM <br />A/C - air handlinc� units <br />Forcod air syslems <br />Gas piping <br />Waler hea�er <br />Gas lireplace <br />Gns ranc�e <br />Clolhes dryer <br />Ranc�o hood <br />Exhausl lan <br />Heat pump <br />Unit hoaler <br />Boiler <br />Refric�eralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby cerility th:,t I have read and exnmined lhis application and know the same lo be truQ and correcL All provisions of lativs and <br />oidinaces c�overninc� this �ype of �vork tvill 6e coinplied with whelher specilied herein or nol. The c�ranlinc� ol a permit does not presume <br />to �ive au�hority to violale or cancel ihe provision ol any olher slate or local Ia�v regulating construction or Iho perlormance of <br />conslruc�ion. Thal I am authorized by U of this proper�y to perform Ihe work lor �vhich applicalion Is made and I comply with �he <br />Stal`Co� hi 18.2��i � .2001/ C. <br />5���1 <br />