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� P�r�MIT APPL�CATIG�J i I <br /> I CITY OF EVERETT PERMIT SERVIGES j <br /> i 3200 CEDAR STREET, EVERET', WA 98201 �, �`1) ,18 i <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org �lw v <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& rREDIT CARDS ARE NGT ACCEPTED I <br /> SITE ADDRESS �j/t/ - �jlG,S�� � pqRCEL TAX I.D.� RMIT� I <br /> ��=-��4�; �r�� _�}' . <br /> IEGAL LOTNO. BLOCK TRACT <br /> � o=sc. 3 7 C /1/vi /�i=.t.L <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> /��.� ��z� L�v��C �j,G'�� 9/v �`�..4,, �23 6 `fL�-Z � y 8 a z ,� � <br /> TENANT NAME �I CONTACT FOR PERMIi PHONE <br /> I <br /> i •J��v�.i ��n�, .i�0 9�? /% s'� <br /> CONTRACTOR A6JRESS CITY/ZIP PHONF. <br /> �40 /��.-� �>�E LC C <br /> CONTR. LICENSE# <br /> �"/��'�'C,��` O/2 G6' �/��/iY9�J CJ-<<� � Z.'6 Jrro-3'SV"S�CGY <br /> USE OF BUILDING HE,�T SOURCE CONTRACT PRICE Of WURK <br /> �/ /`� ' I _Electric _Gas_Other I �� Sv� <br /> WORK DESCRIPTION --- �� �� ' <br /> V � � �. � � <br /> � .�� h'U»..� .� � c' ,, ,�;� . - =' <br /> �d�� ,�- / � <br /> � _ = S,�o�:��,._ <br /> �� �'�., �-.� ' � <br /> PLUMBING MECHA�ICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IiEM <br /> � Toilet A/C—air handling unils <br /> � Bathtub � Forced air systems <br /> Lavatory(wash basin) Gas pipir:g <br /> Shower Water heater <br /> Kitchen sink& disposal / Gas firepiace <br /> �— Dishwasher I Gas range <br /> Clothes washer � Clothes dryer <br /> i Laundry tray / Ran�e hood <br /> Sink(servicelbar/mop/etc.) � [xhaust fan <br /> � Backflow preventer Heat pump <br /> � Urinal � Unit heater <br /> � _ Drinking Fountain Boiler I <br /> � _ Floor dr�in Refrigeration i <br /> _ Grease trap _ Woodstove � <br /> _ Roof drains Other <br /> Other -- � <br /> i — I <br /> i I <br /> CITY OF EVERETT LOCAL SALES SAX COOE IS 3105 � <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and I <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not The grantiny of a permit does not presume <br /> to give authority to violate cr cancel the provision of any other state or local Iaw regulating construction or the performance of � <br /> construclion. That I am authorized 6y the owner of this prooerty to perform the w�rk for•.vhich application is made and I compty with the <br /> State Contrac:ors Law 1827 C1y and 296.200 WAC. <br /> � (/��°a � /Z oy- �'L <br /> Signature of Owner/ ontractouAuthonzed Agent D te u I <br /> I <br />