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i <br /> PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8010- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 1'O 4 PM �� ���0 7 <br /> SITE AD�RESS PARCEL TAX I.D.ri PERMIT# <br /> I 3°l Rt�cr�t_r. oo �� 3� z �+ �t v� i oo C7�9 - J <br /> LEGAL LOT NO.'I BLOCK TRACT [71 V <br /> DESC. � v L �_�'I t.� [✓c/Lf'�+� � fZ. <br /> OWNER ADDRESS CITY2IP PNONE <br /> ��%��Y�� � .)�� ��I �'�1.2C(Ct:a- /�}"�.� � V ��oZol <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> U wn+C '� Jar� oGor=�'L1�A NZ5 Z�L I K�'� <br /> CONTRACTOR 0�1� ��LVG��+n�f ADDRESS O r ' �' CITY2IP PHONE 17�5 <br /> I <br /> t ��,.'S`wuc.liw. �u; Y.� L.�c. �u=,.�t;�°Z•� 'Z3Z- I�{2iZ <br /> CONTR.LICENSE# <br /> Pr'.uor oc9�t�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C7(� _Eleclric �Gas_Other � `�� <br /> t <br /> WORK DESCRIPTION <br /> p�Fn��2 �1��,�+ri�� uf�>rAr�.S R��f°n�� FN� ��w5r�a� <br /> � <br /> i L Ow�°�" R^�J i'sA�7�! . � I?-L'�rn,.v (S�? ;F � !+-E�..tirdtc_ �t`i'r 5F� <br /> PLUMBING MECHANICAL <br /> ti0. TYPE C�f FI%TURE OR ITEM NO. TYPE OF FIXTURE OR IiEM <br /> I Toilet FVC-air handling units <br /> y Dalhlub Forccd air systems <br /> Z Lavalory(wash basin) Gas piping <br /> �_ Shower Waten c�ater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dish�v��sher Gas range <br /> Clolhes washer Clolhes dryer <br /> _ Water healer Range hood <br /> Sink(service/barhnopletc.) �� Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor Arain Refrigeration <br /> Grease frap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3705 <br /> I hereby cerilify Ihat I have read and examined this appliwlion and know lhe same to be true and correcl All provisions of laws and <br /> ardinaces goveming this type of work will be complied wilh wheiher speci(ied herein or nol The granling o(a permil does not presume <br /> U give aulhority lo violale or cancel the provision of any olher state or local law re�ulaling construction or lhe performance of <br /> ;^.o;truction.Thal I am aulhorized by the owner of ihis property lo perlorm the work for which application is made and I comply wilh the <br /> :tc��le Co Hac�i>rs L �� .27 RCW and 296.200 WAC. <br /> �� '�i <br /> � � 9-�0�-�� <br /> SignaWre ol nedConitaclodAuthonzed Agenl Date �/- <br /> rl <br />