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�� <br /> i � � <br /> PERMIT APPLICATION <br /> GITY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> - r <br /> ; ,�,s _o�� <br /> � APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ;'J , <br /> � <br /> SITE ADCpESS PARCEL TAX I.D. N ERM17 a <br /> `J .d�=�`J :JIIEC` �i-�D 2��` ��ocZ ol�o � D �S �� � <br /> LEGAL LOTNO. BLOCK �!- TRACT r <br /> DESC. � t'�I�IJI�1� J 2C�(7'J 0�2�j`J�J� �p <br /> OWNER ADDRESS CITYIZIP PHONE .I2s ,r���,-1787 <br /> T�c� � A�,Socap-rc ;�, I��o� r� .� , SAM��P,M�S�! � ���0`7 Is��JA,N���,4 98oz� , <br /> TENANTNAME CONTACTFORPERMIT PHON <br /> i t� .i� . ��c�4� Po�T�R '��•557• 718-7 <br /> CONTRACTOR p ADDRESS CINIZIP PHONE <br /> � �1J,1� � � <br /> CONTR.LICENSE# <br /> -�:'Jy�7��,c �__,� � r�r�.I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �C�(���� _ElecUic �Gas_Other � � �d�0 O <br /> WORK DESCRIPTION � � ( `— {_ �J !�(p(7 S"1' � ( d <br /> �'4— ��9-J C. o �vy lc..� 0 0.; 5 I' C I Y1 G � �✓L� <br /> (� i <br /> Ia�Scc,�,,.1�� � ��aJe� '�nr���1� � � �t. `i`h'jl sT eat2 7`�or� rC��� �� �I�� I <br /> W IQYI`7 1 0(' �"Y�L- C.OYIS�4� 1 a Vt L'\ ct �✓�V!`C� 2 1 .�JV S� r�5�`l✓�4 r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile� A/C—air handling units <br /> BatMub _ Forced air systems � <br /> _ Lavatory(wash basin) � _ Gas piping ! <br /> Shower _ Waler healer I I <br /> Kitchen sink 8 disposal ��� �C � 1 _ Gas fireplace � �C1 I <br /> _ Dishwasher ��e � _ Gas range `¢ C� � <br /> Clothes washer - is _ Clolhes dryer � C . A <br /> Laundry tray \-�1�� _ Range hood ,nn� <br /> Sink (rervicelbar/mop/e�c.) ��� � _ Exhaust fan SV� <br /> Backllow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodsrove <br /> Roof drains Other <br /> Olher — <br /> — I <br /> -- — I <br /> CITY OF EVtRETT LOCAL SALES TAX COOE IS 3105 <br /> I heieby ceritify that I have read and examined lhis application and know lhe same to be true and correcl All provisions of laws and <br /> Iordinaces goveming ihis type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> �o give aulhority to violate or cancel Ihe provision of any othei state or local law regulating consirudion or Ihe periormance of � <br /> � construdion. That I am authorized by Ihe owner o(this property to pertorm the work(or which application is made and 1 comply with ihe <br /> State Contrac o�/.�w 18.27��CW and 29G.200 WAC. / <br /> /��I/ / ��,//"l 3�"�' �7 <br /> , SignaWr of wiiENCo iractor/Authonzed AgeN Date � fz <br /> � <br />