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i <br /> � PERMIT APPUCATION <br /> CITY OF EVERETT PERMIT SERVICES � � - 06 _o� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetiwa.org �=f�'r� � ; � -�;�'� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AODRESS PARCEL TA%I.D.p ERMIT R <br /> �, , .,`; 2 o cp3o22ov 7�'G� :5� <br /> LEGAL LOT NO. BLOCK TRACT Ofl S�IBDIVISION p <br /> DESC. �� <br /> OWNER AODRESS CITY/ZIP PHONE <br /> pArapc j-t�1 tx=v�oP�-n�iJr (44�swtNcFr.,rCiR C�ElrC�1� ��i81b$ 2ao- 2'{8•�-SS <br /> vMP,aUY f�Izkl,�ta-t, Su�TG Sti2 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �au LLhcu.�P q2s-C�c�- t8ca <br /> --- JaLJ, L L>G��l A P SY.�T�SESISPG.GoM <br /> ��,4w -r:�N� lc��oo so.n-���.YcE2 Seni��f 2�-a3S• ��lo <br /> CCnIS�Ci�ctlt�J InY. <br /> CONTFi.LICENSEM � 1�'A.(LKWAY,Su�tE. So2 �1��� � ; _ <br /> f AtJ A�Cc 19UN� � <br /> i- <br /> �� 9/nQ /.S//'> �`,7 <br /> c <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRIC�OF WORK <br /> Cj�o(ZACi�E/oFFtGE _eiea��� �Gas_Ou�er �' ��258� �a7•oo <br /> WORK DESCRIPTION f��� �j`�i �j S� -'�l�,"t" �[kJ��'j'� <br /> I�ous�ct��,A� -�.�1LO��.Ic� . <br /> 13v��..(�irJC� �G` <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OFl ITEM NO. IYPE OF FIXTURE OF ITEM <br /> Toile� A/C-air handling units <br /> 6athtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas lireplace <br /> Dishwashcr Gasrange <br /> Ciothes washer� Clothes dryer <br /> Waler heater , Range hood ��` <br /> Sink(service/Dadmopletc.) Ezhaust lan I �� <br /> _ Back�low preven�er _ Heat pump �1(,�`� <br /> Urinal Unitheater ���.' <br /> _ Drinking Fountain Boiler {�i�'J <br /> Ffoor drain Relrigeration ` <br /> �Greasetrep _ Woodstove <br /> � Rool drairfs SC✓QP�(t$, _ Other _ <br /> otner <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify Ihat I have read and ezamined�his applica�ion and know ihe samr,to be Irue and correct. All provisions ol laws and <br /> i ordinaces goveming Ihis�ype of work will be complied wilh wt�ether specified herein or not.The granting ol a permit does nol presume <br /> � to give authority to violale or cancul ihc provision ol any olher state or local law iegulating construction or the pedormance of <br /> conslmcli^.n.Thal I am authorized by ihe owner ol this propehy�o perlonn the work for which applicalion is made and I comply with ihe <br /> Statc ors �' and 296 200 WAC. <br /> / �l <br /> � r•t/ <br /> ISigi ti re oi Owner/ ntractorl^ulhorized Agent1 Date - — �/� <br />