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[� <br /> PE�MIT ��PLICATION <br /> CITY OF EVERETT �Ei�MI� SERVIGES <br /> 32C0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ��Z�`�� PARCEL TAX I.D.# PERMI7# <br /> •��-- ��c>`k-- :�� �Jl �l`S'� 5 �'c�b�,sy-LSLv`�c%U ��l0'70(�— o�O <br /> LEGAL LOTNO. BLOCK TRAC7' <br /> DESC. <br /> OWNER - ADDRE55 CITYIZ:P PHONE `I.LS <br /> `.�h �r� \�`��is �i25 ���-- St �:���c�s'� `t=-�-�� �l�zc=� �=�Z `��`, 1 <br /> TENANT MAME CONTACT FOR PE MIT ' PHONE <br /> V <br /> � � 1� � U-.v v�JV �I�J-�)�J�.�-i<. L!7�:.1." rV �`il`���Y] Ll <br /> CONTRACTOR • / ADDRE55 � i � CITY P PHONE <br /> ��l/AsN�a���7r>7 LGv:AT� � j;,y�,� ,� !l�lz� / " �-�;L� — <br /> CONTR.LICENSE# �" � /Ly n 'J���` :./�SN �I S J��/J/ <br /> CG�iI`J�-/�JC�/l'�I�CJ� � (1 -�' 3�� <br /> USE OF BUILDING ,� HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,�Electric _Gas_Other 5(�,��� ��' <br /> WORK DESCRIPTION <br /> �� �.c��,�;c c ��� ��l ..�L,: �-E-r ,� �:`c��� �-Cs �.�(-�:Z <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE(1R ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&dispo^al Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Laundry iray Range hood <br /> Sink(service/bar/mop/elcJ Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains � Other <br /> �_ Otherl�J:',�-' 1�t , _1 � � — <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 � <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of Icws and <br /> ordinaces governing this type of work will be complied vnth whether specified herein or nol. The granling of a permit does not presume <br /> to give autnoriry to violate or cancel the provision of any other stale or local law regulating construction or the performanre ot <br /> conslruction. That I am authorized by lhe owner of ihis properry to perform the work for which application is made and I ccmpty with lhe <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> C���-�2� _ �l�ltrSLS�. A—�3 `C%1 � <br /> Signature o Owner/Contrzclo uthonze gent ' � Date r. <br /> �__ <br /> -- _—.�____�_.__. _ . .T-..-a-^-c,.. „ . - <br />