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PCRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA �8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATI�JhS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> �ro3� I`-'� � SC �v�v�tliUvh �hZ03 UII�S' 9UGC07"1D0 CD —� � <br /> LEGAL LOTNO. BLOCK TRACT J <br /> DESC. �� v� p-(�(� Ri C�,(,GO[q TZVYA '(,�', �iv. no. 1 <br /> OWNER ADDRESS CITY2IP PHONE <br /> ; ;! '�Il�� .T)I�i�� �;li3L l i� ��' �J�' C'�/P/VCtiI, g 252��' ��/.S) ?J�1'�'3�FU <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,'tIIL'i,� �I� la�I�L�(� Sv�� (�jG��L3G- I)�I� <br /> CONTRACTOR ��� r�)UC'����1 T�7C�,�' �(,�� , ADDRESS � CITYIZIP P ONE <br /> � � i 1I� �q � '1 <br /> CONTR.LICENSE# GUI7 �/. C� 7U�D � 11 ��/ `��c��""`�1 `!�� �'"� <br /> �R01�ut*�yi��ST I ��oQUUT751 l�w l�IZS) �I D- Ub 52 <br /> USE OF BUILDING I HEAT SOURCE CON1T ACT PRICE O�F`WORK <br /> �n ,,( ,- �! �� LUV� �1U <br /> A�I Lld/V�� _Eieclric X Gas_Other � <br /> WORK DESCRIPTION („r�Jr. ����^, M1SyC 5, V'YCI,YYI Vvlr� � ✓�n✓�/' I �t l�'�� � <br /> �,h�w�j nM cl �dM�� �.f. �}n 'j1'u -�6�,chl� �+l�l N LR�,�G . <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Dathlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clolhes washcr Clolhes dryer <br /> Waten c�ater Range hood <br /> Sink(serviceNadmop/elc.) Exhausl fan <br /> 6ackflow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Flour drain Refrigeration <br /> Greas�lrap Woodstove <br /> Roof drains Other <br /> _ Other_ _ <br /> CITY OF EVERETT LOCAI SALES TA%CODE IS J105 <br /> I hereby cerilily lhal I have re2d and examined this applicalion and know the same�o be lrue and correcL All provisions ot laws and <br /> ordinaces governing this rype o(work will be complied wilh whelher speci(ied herein or noL The granting ol a permil does rol presume <br /> to give authonty to violate or cancel lhe provision of any other slale or local law rec�ulaling construction or lhe pertormance of <br /> st icliai.Thal I am authorized by the owner of Uiis property to perform the work for which application is made and I wmply with the <br /> 'Stat nlraclors L�d� 1827 RCW and 296.200 bVAC. <br /> � �. ���4"��1, ��� i`�l`� z v D� <br /> Si�r��turc ol OwnedConir t dAuthonzed Agent Date <br />