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1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98301 <br /> 425-257•8810-FAX 425-257-8857-www.everet�wa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.• PERMIT � <br /> n <br /> ! � Q r< < . � �1U � 0 U� ' �� � �L <br /> LEGA LOTNO. BLOCK TRACTORSUBDIVISIONJI <br /> DESC. �1 7 . +n,J �tTI � Y <br /> OWNER ADDRESS CITY2IP PMONE ��y <br /> Z`-fi�u.�iJ�G� J-'�.,� . <br /> T�uCF. �1�t4`L7jtiton� U--�� Il�(� t11� !�,�-�0..Hi�� l,l,l l�� iW `�50� -nSvt_ <br /> TENANTNAME I C1ONTACTFORPERMIT PMJNE �3 �� -SI�U <br /> ��c:R,,l L�So I��ie I�lurcl�5 �e�a� uId a ��r,n-�L': � <br /> —�jj _-_.ADDRE$$ `R'Y7ZIP PMONE �Ti.(ii <br /> �,ii�i�-�Yu�� :��7tru�tii��l,lC. �U f�-'� �ti01�1 QU;ncJiM 13J-1 �l�d oZS� ��J`I -SI�tO <br /> CONTA.LICENSt N <br /> LIN�,( i�C� v��)i-'C ��7��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �Gas Other `� r(� C �� <br /> ��A� � _Eleclric _ �'10 � �� 1 - <br /> WORKDESCRIPTION f-�.� },1� c�.��,+, ..�`�1i`,�� 1"�%�• �,✓�1-�l�n I.LIC��Si 6'12U: C�'t�nj v {�p,;y�ry� <br /> '�uni , l'1i���� '�DV��IQ. �lu„ilx�� YLus��-u , -hr �tcllvf. ��lcJfti,�*f�.. �Yl��- ��i`S�iCOtl <br /> CYLI�b. �� uyl`S�p��r- <br /> la D�a��Fi-wil'��� Y`_,,1 � �� <br /> PLUMBIN MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TVPE OF Fl7(TUHE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> f(itchen sinh 8 disposal _ Gas fireplacc <br /> Dishwasher Gas rangc <br /> Clothes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/badmopletc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Doiler <br /> Floor drain Retrigera�ion <br /> Greasetrap _ Woodstove <br /> Rool drains Other <br /> OUier <br /> CITV OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritily Ihat I have read and examined Ihis application and know ihe same to be true and correc�. All provisions ol laws and <br /> ordinaces governing ihis type ol work will be complied wilh whether specilied herein or not The gran�ing of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other slale or local law regulating consWction or ihe pedormance ol <br /> conslruotion.Tha�I am aulhorized by ihe owner of this property to pedorm Ihe work tor which application is made and I comply with the <br /> Slate n r tors Law 1827 RCW and 296.200 WAC. <br /> � ' " �-V��(C' I - I(o -0 <br /> Sign ure_I OwnGf/Con�i�ctor/Authorized Agent Date � <br /> Ll!)t <S�`�l) ��V"YJ�I�i[���l�n� l.�l.. <br />