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( ' <br /> �- - PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVE^ETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL fA%I.D.k PERMIT X <br /> ^ � <br /> c ,,- ,>>� �'c,� �� .��zr� � :�� 2�� c�ll Zoc Z::i3CK� a 6 <br /> LEGA LOT NO. BLOCK THACT OR SUBOIVISION 1 <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> '� .1�/07 �Yvtq�:�y . <br /> � ���<<-- �)fli [f-��^lr,-_;� /(_C.7 G.w- �:1,�t�/A�,^r5rll�:�/ w.� `I��7.�- <br /> TENANT NAME :,ONTACT FOR PERMIT ' PHONE <br /> C` , jC•`•�:� �ra_� cci�C�..'. <br /> E•MAIL <br /> ��`'.9b4L ^7rC rl,',.`�c'.��L r �/'li 1�9�" .�r �iF � o <br /> 7� iCZ [�.cc'Dr;-in�( �%?; yC: <br /> CONTR.LICENSE q • <<�a ��� �°� <br /> ��il t�i�'I�L'�L�.0� '��'C'�� <br /> USE OF BUILDING HEAT SJURCE CONTRACT PRICE OF WORK <br /> Eiectric Gas Other <br /> WORK DESCRIPTION <br /> ��� '] 1.� ,� �- L',A'lSTi -t%(� `>�1,'�C �- <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilei IVC-air handling uni�s <br /> Bathtub Forced air sysiems <br /> Lavatory(wa,h basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> I Sink(serviceibadmopie�c.) _ Exhaust fan <br /> Back(low preventer _ Heat pu:np <br /> Urinal Unit heater <br /> Drinking Fountain _ Boder <br /> Floor drain Refrigera�ion <br /> Grease trap Woodsrove <br /> Root tlrains Oiher_ <br /> Other <br /> CIN OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> �hereby ceritify that I have read and ezamined Ihis application and know the same to be true and cortect. Atl proc�sions of laws and <br /> ordina¢es goveming this rype of work will be compl�ed with whether specified herein or not. The granling ol a permit tloes not presume <br /> to��ie authority to violate cr cancel Ihe provision of any other siate or local law regulating consiruction or the periormance of <br /> cdnstructioh.That I am authorized by the owner of this propetly to perlorm Ihe work for which appiication is made and I comply wi�h the <br /> ate Co ractors Law 182j�C�Y"and 296200 WAC. <br /> i <br /> �� �L:cL li ", �-7t� J •� <br /> S rfature of Owner Cu��Aa orlAuthonzed Agent Oale V <br />