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�� <br /> Y{ <br /> u� <br /> F, <br /> P�RMIT APPLICAT'I(�N <br /> CITY OF E�'cRETT PERMIT SERVI�ES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �� , �C/,` i <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org vl 7 <br /> APP!.lCATIONS ARE ACCEPT'ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCFPTED <br /> . I <br /> SITE ADDRESS PARCEL TAX I.D.!f P�jtMIT# <br /> � �� <br /> 5�0 �/6T . T. f. 3t �9Js c�o o __ �:; <br /> LEGAL LOTNO. BLOCK TP.ACT <br /> oesc. �=A/L1QtRL� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> i4 �� P/�RkC�'Ffk LLC P,D,/�ox 9/o CLi�trT"o,T/ 98�3c �da-3yi-vv;�s - <br /> TENANT NAME I CON7ACT FOR PERMIT PHOr;e �, <br /> i <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE � <br /> I� �- .CJ �'i�R�l'C!'i f£(c L LC I <br /> CONTR.LICENSE# I <br /> N/��f'kc��Eo �z� B P,�,�OX `//o C[/NTo,1/ 98z3G 3Go-•3y;- y'/`/S- �I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> $/•UGL £ F�/1/yJ/L� ,d�'£LG/�GI _Electric X Gas_Other 9y� 000 I <br /> WORK DESCRIPTION ' <br /> �I <br /> C_a.USTiPUcT N�'u� SlA/GL �' F�/'7/G � J�I.!!F_ LL )�i/G �j� I <br /> � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM '�, <br /> �_ Toilet A/C—air handling units — I�, <br /> �2_ Bathtub / Forced air systems I <br /> � Lavatory(wash basin) �— Gas piping <br /> Shower `'1 Water heater <br /> �_ Kitchen sink 8 disposal � Gas fireplace ! <br /> �_ Dishwasher �_ Gas range <br /> _L Clolhes washer � Clothes dryer <br /> Laundry tray �� Range haod <br /> Sink(service/badmop/etc.) �i Exh2ust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> jDrinking Fountain Boiler <br /> I �_ Floordrain _ Refrigeration <br /> Grease trap Woodstove <br /> i — Roof drains = Other , � <br /> i I _ Other _ _ <br /> � <br /> � CITY OF EVERETT LOCAL SALES SAX CODE IS 9105 <br /> i <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All prov�sions of laws and � <br /> ordinaces goveming this type of work�.vill be complied with whether specified herein or not.The granting of a permit does not presume i� <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of �r <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the � <br /> State Contr2ctors Lav�'I8. 7 RCW �296.200 WAC. <br /> /i / <br /> I ��.t�� �r,. � �/-� 7-vs' �: <br /> Signature of OwnenContractonAuthorized Agent Date ��� � <br /> � <br /> — � <br />