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* - — <br /> - - ----- t - � <br /> PERMIT APP'LICATION � <br /> CfTY OF EVERETT PERNiBT SERVICES <br /> 3200 CEDAR STREET, EVEREIT, WA 98�01 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �( -a 7�-D� i <br /> SITE ADDRESS PARCEI TAX I.D.N PERMIT q � � <br /> 2b01 / � n � �� z• OuG> >-_ ' liU% I I ( � — <br /> LEGAL LOTNO. BLOCK TRACT � '( r ^l I <br /> DESC. (J'' T7— I �'�� 6�AI�lLNLL.0 I �I <br /> OWNER ADDRE&S O1TMZP�152�•c> PHONE I <br /> 2�u1 /-� �y��) <br /> �.St�'� ���. (�t�r \ �,,���c r�:�i- I��e- ; F�e,�vt�- si�-5y �i I <br /> TENANT NAME CONTACT FOR PERIdIT PHOHE �i <br /> ��(;#�t r�.,0 UWt�„W� �C��l��'�G- �^�� � �1a1�� %� f-��58 <br /> CONTRACTOR ADDRE55 CI,]Y/ZIP PHOH �i <br /> Pa�.11i�.►'<< Nt-4��rr� �l� Svc�, l���. 4�7��� ���IIr-�r,�( Avr� tiiW; S,�,�-f4�, lr��� (=.ti��7�4-kl�l , <br /> CONTR.LICENSE����I �I`�L'IU���� <br /> I — <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � - Eledric �Gus_Other .� ��� h�� ' �rt� ' <br /> � I i�+�� �� i� '� � � — /1 — <br /> WOR DESCRIPTION �i �nJU� ��;�,a��� � Q �'uV-� (4LL� .U�� Il(�W IYIl.��1L �hlY{1/�;� <br /> (� V� <br /> Ili +��-C Zu� .i��U,� ���it�-{l�(>ta. �L1Aft.W�� tllM� �'� �-t�1.��CtV- .U�r•'+f✓� .U'1�{v ���-�L ��c�/`.rl-{n�R . <br /> � . � } t) <br /> � .� �.,,,y�- .- I <br /> �l l`-Z_����/ .�LU 1 �+.n {�1I^•!1`.; -{ y'�(i� -��U� i�� �A.O r� ���i4�'�^F�i -i -{ i 1'I ��li(Z ��l:a��Uf'�!^- �I <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' Toilet A!C-air handling umts � <br /> � Balhtub Forced air syslems i <br /> � Lavatory(wash basin) � Gas piping � <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Ges firer.iace I <br /> Dishwasher Gas renge I <br /> Clothes washer _ Clothes dryer <br /> _ Laundry tray _ Range hood I <br /> I _ Sink(service/badmop/c�c.) = Exhaustfan I <br /> Back9ow preventer Heat pump �I <br /> Unnal Unit heater I <br /> Drinking Fountain _ Boiler � <br /> Floor drain Refrigeration <br /> I = Grease trap Woods�ove p �, <br /> Roof drains � Other ���,� � '`�+�V"7�1.u.. <br /> � _ Other — ', <br /> i — � <br /> — I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 i <br /> � I hereby cenLfy that I have read and examined this application and know the same to be Uue and covect. All provisions of laws and II <br /> �� ordinaces governing this lype of work will be complied wilh whether speaGed herein or not.The graNing of a permi�does not presume <br /> '�, to give authority to violate or cancel the provision of any other stale or local law mgulating construdion or the pedormance cf <br /> I constmdion.That I am authorized by the owner of this property lo peAorm the work for which appliwtion is made and I comply with the I <br /> � Stapa`Contractors La 1827 RCW and 296200 WAC. <br /> \ . .L � � '`, ��;_ I <br /> c c v r m.r,� :� � <br /> �ignaWre oF wn or�� or! uthonzed Agent Date <br /> ( --�'�- <br />