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— — --- — ---� <br /> PERMIT A�'PLI�ATION � <br /> CITY OF EVERETT PERMIT SER!/ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 Ph� ( l � � ltS <br /> SITE AiDRESS ��� � PARCEL TAX I.D.# PE IT# �) <br /> �c�, l% —'Q���_ <br /> LEGP.L LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> �ESC. — <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �f}n� Wr�l4� � LG-C Ly�l v 38� Si �i�i� `1�2�� — ��^ <br /> TENANT NAME CONTACT FOR PERMIT 11 � PHONE C{ZS���'3��I ZZ <br /> �� t�/ �' c71���.� L°ra.,��rcx � <br /> ��CIf"L� N/` �"`� 5�� � E-MAIL <br /> CONTRACTOR AODRESS CITYlZIP PHONE <br /> �u�N� D , cr2�Nr.��rc��Ne ��a� ro���'� � ��Tt, � �3 <br /> CONTR.LICENSE# /�zsr �'3tf] 'o�z Z <br /> USE OF BUI�DING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �c� �NT�. G�.1 <br /> ���7��L f�us� �rT/C� _Eleciric _Gas_Olher <br /> WORK DESCRIPTIOv . <br /> �Gl�tuJ� � (Zf�u�c�. R�r�n��. /��y w�A�7.1L s r4s R)����b To <br /> (1-£A�i2- ��Y �'oT ,,v 2t�fi /f-r 5� if-,e�}- oF �A6 . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> BalhWb _ Porced air systems <br /> Lavatory (wash basin) __ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br />� Water heater _ Range hood <br /> Sink (service/badmop/elc.) _ Exhaust Tan <br /> Backllow preventer _ Heat pump <br /> � _ Urinal = Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain _ Refrigeration <br /> 11 Grease trap _ Woodstove <br /> �' Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby certify lhat I have read and examined this application and know Ihe same to be true and correct. All provisions of lavas and <br /> ordinances go��erning this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give aufhority lo violate or cancel the provision o(�ny other state or local law regulaling construction or ihe performance of <br /> consiruction.T al"�am authoriz by lhe owner of this properly lo perform the work for which applicalion is made and I comply wilh lhe <br /> ntra rs,�aw 18.27 R and 296.700 WAC. <br /> ' '� n ^ / ^ <br /> S ature of Owner/Coniracto Authorized Agenl Dat� '�/ <br /> �� <br /> L <br />