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I <br /> FERMIT APPLICATION <br /> CITY OF EVERETT PtRMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA%I.D.if PERMIT p <br /> 'L . Yi��I-i, a-�s-c� � ' �l c� �o�l.� - 2 <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONp <br /> OESC. <br /> OWNER ADORE55 CITV2IP PHONE <br /> f '� yZS 'ZS�� <br /> �I� L `�C4.� �lJZ I �. 111� ��t- G�15('�Y'F� �-11v�-�j��I ��S <br /> TENANT NAME CONTACT FOR PERMIT PHONE 4 ZS-7'](n..�� <br /> �'�"�L`T����OV-lrl � V L`C�'{- S(� �5 �t�a E-M�A L{S�S�1 T��m <br /> �vU �e.Q.1 �'�J,� �6�^r�LS 7YOo tk-6L�d Esia� ,,��- 7 7l0-&�S'3S .. <br /> CONTR.�ICENSE p <br /> �r-eI�yNC � �-�Gr� ��re� t,�� �tS2o� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /-• � �, „ /,1 _Electnc _Gas__.Other � / C/J �v <br /> i_a".�1� �-6`--+� � ��� . <br /> WORK DESCRIPTION <br /> �Y�S�ZC-�.� Ov�Q.. �''Y-J I ' �C���.L.�-P.d' �vt'i�S�l� LL.Q l.cavti vr-c�r ���c�c.�>"Z�Lc� <br /> � �N I � tn`�,k�cf `�n;� . �f- � <br /> .� l��^e-t�1 1,�� �S �� •-rt�CP C-U,�- pu`� � � � G�t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM N0. TYPE OF FIXTVRE OR ITEM <br /> ��1 ( Toitet �1/�!}- A'C-airhandlingimits <br /> Oathtub 7� Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower N'aten c�ater <br /> Kitchen sink 8 disposcl Gas lireplace <br /> Dishwashcr Gas range <br /> Clothes washm Clothes dryer <br /> Water heater Range hood <br /> Sink(servicePoar,'mopletc.) Exhausl lan <br /> _ 6ackllow p�eventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Founiain 6oiler <br /> Floor drain Relrigeration <br /> Grease Irap Woodsrove - <br /> Roof drains O�her_ __ <br /> -- – Other -- -- _–_--- — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerility that I have read and examined this applicaLon and know the same to be Irue and correct. All provisions ol laws and <br /> ordinaces govemin�Ihis type o1 work wilt be complied witP whether specified herein or not.The yranting ol a permit does not presume <br /> to give authority to violate or cancel the provision of any eiher state or local law regulating construclion or the pedormance ol <br /> construclion. That I am aulhorized by the owner ol this p�ope�ly lo pertorm ihe�vork tor which applicalion is made and I comply with Ihe <br /> S Gmtractors Law 1827 RCW and 296200 WAC. <br /> � � ��� 1 i. _ � � �� � <br /> ' j.. �� <br /> � �gnaWrc of wnp/Contractor/�uthorized Agent ate 1 / <br /> iY <br />