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�rERMIT .AF'PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FNC 425-257-8857 —www.everettwa.org <br /> � �'��;'�, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> '� SITE ADDRESS PARCEL TAX I.D.# ' PERh71T� � <br /> ' _�'-�'r-� 3:,.� ,}�t SC �:c;3".� ���oo �oi. - oc, ' � '> <br /> ' :EGAL LOT NO. OLOCK TRACT <br /> � ❑[SC. , / /J <br /> i OIYNER u/li /J O C���C C/O✓L N LOAc�IU <br /> ADDRESS C 21P PHOt�E <br /> i (•r�[:'�`[lc ��la�^�t'S ��.�.7� Li��. �.L/S!�`I 'uFF�/�1.�5 L-5� L/t S/r��r.t5 %�YZ��`1. <br /> '� TENANTNA�dE CONTACTFORPERMIT PHONE <br /> i <br /> � ' //�C.�Y C'n��� y�.Z�= y2 Z—/>> �� • <br /> �I CONTRACFOR �-% �� � � ADDR£SS�r—� � " � dTY21P '� � �PHONE �� � <br /> � /'rrcva:'h,�c C/��,'/rs �W:sttir, �Z( 5/:i N/_= I'illii G—Y Gk Stt✓a?s <br /> , CONTR.LICENSE# �., , � � . ��• •� <br /> I i�'/)GCCvs J[7� -ti.�i�i ��U�ls 3�'G� ' i <br /> I US[ OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> i <br /> � ���� �Electric _Gas_Other �/(J�/,U(��� _ <br /> I WORK DESCRIPTION I <br /> ��, ���,�'12��� � y��,�1 C- ��� ��, <br /> PLUMBING MECHANICAL , <br /> INO. TYPE OF fIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEtd <br /> I _ 3 Toilel A/C--air handliny units ��, <br /> I _.L �athlub Forced air syslems �I <br /> _j Lavatory(wash basin) I Gas piping , <br /> Shower ___(_ Water heater � <br /> ; _J Kitchen sink&disposal � Gas fimplaco � <br /> '� i Dishwasher Gas range � <br /> _L, Clolhes washer _� Clothes dryer i <br /> �} Water healer _�_ Range hood <br /> Sink(service/bar/mcp/otc.) �_ Ezhaust fan i <br /> ; Backilow prevenler Hoal pump � <br /> Urinal Unil I�ealer <br /> � _ Drinking Fountain Boiler , <br /> ; Floor drain R�fric�erelion I <br /> I, Grease trap Woodstove <br /> �, � Roo(drains Olher li <br /> 'I Olher i <br /> �� CIN OF EVERETT LOCAL SALES TN:CO�E IS 3705 II <br /> � li <br /> i I hereby cerilify that I have read and ezamined lhis application and know lhe same lo bo We and correct. All provisions oi laws and I <br /> Iordinaces governing lhis lypo o(work will bo complied with whother speci(ied herein or not.The granting o(a permit does not presumc <br /> to give authority to violato or cancel the p:ovision of any olher slato or local law regulalinc�construction or tho pedormance ot <br /> I construction.That I am authorized�y tho owner of Ihis property to perlorm lhe work for which applicafion is made and I comply with Oie <br /> Stale Conlractars Law 18.27 RCW and 296.200 WAC. <br /> iSignature o(OwnedCnnlractodAuthorized Agent Dalo I / <br /> � Z <br /> ._ --- — —�------ — <br /> � <br />