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— i <br /> P��2MIT ,APPLIGAfilO�� <br /> CITY OF EVERETT PERMIT SEftVICES <br /> 3200 CEDAR STREET, EVEr�ETT, W.A 98201 <br /> 425-257-8810- FAX 4�5-257-8857-www.everettwa.org �, i __ � <br /> ��i ' -- '�' - _ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM ''O 4 Pld - GEBIT& CREDIT CARDS ARE NOT ACCEPTED, � <br /> SITE ADDR�SS PARCEL TAX I.D.# PERMIT# <br /> �� �� �� � sr. 3 �� 9os3�� ,��o� � ��: �a- va/ <br /> LEGAL LOT NO. BLOCK TR/P�C_r v � ,� 3 �o -3 vi-�c� `/ <br /> DESC. �� l�-�ii+x�G ��/ L��..��4�., � l,Ja `/8,.� 3 v <br /> OWNER ADORESS ,iJ� CITY2IP� PHONE <br /> ��-n � / � � � o -�v,-���•i <br /> � v�' L��/< ��C /��D /1'X �/c ��-4:, � Lv-c 9bZ3t <br /> TENANT NAME � Cf1NTACT FOR PERMIT PHONE <br /> lfcL'i' /'JC�c�-> �/1.S - `!zz 0377 <br /> T�7.�, .D��..., 3 �� .4z9 - iys3 i <br /> CONTRACTOR ADDRESS� CITY2IP PHONE <br /> K'4/� /�cur.�Gu�r/�Lc �G ��3f� - �fGo ,f <br /> CONTR.LICENSE# <br /> !°�1.c/rc�c -i� ;v z <�z /^'D 6�n 9io G✓-c��, � C✓ a sY-�c <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PF�ICE UF WORK <br /> ,5�,�,�t ��� r`�' _Eler,tric �Gas_Other C`� �G U II <br /> WORK DESCRIPTION <br /> � � � �{� � � <br /> / ,y,cJ .)-env �G�� rKJ u�-e�f+-�:� `�Y�7-c..c.L',.tti � <br /> � 'C,/ <br /> PLUMBING MECHANICAL. I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I'i EM <br /> �_ Toilet A/C—airhandlingunits <br /> � Bathtub � Forced air systems , <br /> Lavatory(wash basin) h'/. Gas piping <br /> Shower / Waterheater <br /> _L Kitchen sink 6 disposal � Gas fireplace � <br /> � Dishwasher �_ Gas range <br /> � Clothes washer Clothes dryer � <br /> Laundry tray � Range hood <br /> _ Sink(service/bar/mop/etcJ ���_ Exhaust fan <br /> J ; ackilow preventer Heat pump <br /> Lnnal Unit heater <br /> Drinking Fountain Boiler i <br /> +_ Floor drain _ Refrigeration j <br /> I _ Grease trap Wuodstove <br /> I Roof drains Other <br /> Other <br /> _ I <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> I hereby ceritify that I have reaa and exam ned this application and know the same to be true and correct. All provisions of laws and i <br /> ordinaces goveming this type of work�vill be complied with whether specified herein or not.Tha granting of a permit dees noi presume <br /> Ito give authonty tc violate or cancel the provision of any other stala or local law regulating construction or the performance of I <br /> construction.That i am authorized by the owner of this property to perform the work for which aoplication is made and I ramply with tte <br /> I Slate Contra ors Law 18.27 R�and 296.200 WAC. <br /> i �/�/L^��/�� )� � —/2 —�y' �i <br /> ' Signaiure of OwnerlC'ontractoriAuthonzed Agent Date (�� 1 I <br /> �— 1L% I <br />�� _. . ,- ------ <br />