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PERMlT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 99201 <br /> 425-257-8810— FAX 425-257-8857—vnvw.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROh18 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � �"' - ` PARCEL TAX I.D.# PERMIT M � <br /> C��, f<<, , � �? �' ° �Lv <br /> (c- i v��-�1� � i?i'_ �.;��,�ti;•ic>> <br /> LEGAL LOTHO. BLO�K TRnACc�T 1 <br /> DESC. ���C' ���� i7 t 2. �� l0 (�'t f+ST trJ I�2��i_i� fl <br /> OWNER ADDRE55 CINRIP PHONE Y�y ZyJ,C-,�'S�� <br /> � � <br /> C� I t��'�"_'l i� C•i l�fCi�N' `�`�l�C'I �ri���'i: �' k>>2 i'V�'";�`cc i� I��. `'l�5 Z67 <br /> TENAI:T NAME CONTACT FOR PERMIT PHONE <br /> �.a7�lr; r`� �'L.N�C� <br /> CONTRACTORMC���9�,rti: 4.����i1vr� ADORESS "�,�1�; �:lL(lI'l}.(�� CITYIZIP PHONE ZCt. l-=�r.C'�+�-I <br /> �'� 1'�L ` <br /> ti�d�ll�:-� `�C'S«�� <br /> CONTR.LICEYSEfI �t3��vLr�e tC�� .� <br /> USE OF BUIIDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> `�1(�tl t (t1�ti111,�� r`L:)��'�-�� �iElectnc _Gas_Other /Z.7 C� � 00 <br /> WORK DESCRIPTION <br /> R�'�- -rr�� sr�a E a�utA�E -ro SF2. R�A.�CF �liuL F/Zq,NU� a� <br /> Gu�TRUsS�s � fz��+i« 7u�o ��cTrr-�r� cv.fucS r�t/ .f��EcrF0 .4�lf <br /> R�i�� ,¢w ,FFrF,cr� F/N6ffEs <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel FVC-air handling units <br /> 8a1hWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink!servicePoadmopletc.) _ Exhaust tan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re!rigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other __ — <br /> CITY OF EVERETi LOCAL SALES TN(CODE IS J705 <br /> I hereby ceritify thal I have read and ezamined this applicauon and know the same to be true and corred. All provisions oi laws and <br /> erdinaces goveming this type of work will be complied�v�th whether specified herein or not.The granling of a pertnit does not presume <br /> to give authonty to viotate or cancel ihe provision of any other state or local law regulating construclion or the perfortnance of <br /> construction. hat I am authorizedpy the owner of this propeAy to pedortn the work for which applicalion rs made and I comply wilh the <br /> Siate Conl�ors 4aw 7827�GW and 296200 WAC. <br /> � � � /: <br /> i �,l/l�f",�. '-�`��.f:v - r g �9� <br /> , Signature of Owner/Contractor! innzed Agent � Dat <br /> � -- - — - _- . .. . _---- — �--- <br />