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�' � <br />� � � � - -- --1 <br />� �;� i�Er�IVIiT APPLlCATION <br />�'"'�`�"��� CITY OF EVERETT PERMIT SERVICES <br />�4�i�"F. y � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br />�' 425-257-8810 - FAX 425-257-8857 -www.everethva.org Q � <br />� �U��L--�/ <br />�'� �" AP�LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PPJI - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> .�'i;i::�� <br />� SITE ADDRESS PARCEL TAX I.D.# �RMIT# I <br />� �-� / ;�� ''' S T 3 l o s30 `�mo7 ��f 7�� �� <br /> � � LEGAL LOTN . BLOCK TRACT � <br />� � ' DESC. <br /> �` OWNER ADDRE55 GITY2IP PHONE <br />,l � ,:, / 1 3�{o -3 5�/-Yc �.:� <br /> e � K'c^, :�� O I�A�R� C/PEE/r .LL C ���/��/ (._.L �/�i '.'1� �//9 — y0 Z�� <br /> a �: — <br /> ��' <br /> ' TENANY NAME 'I CONTACT FOR PERMIT PHONE <br /> � � . <br /> /� <br />� 2, , ; ' � %J.// /�or �_Ff� . �.ZS �-Z2 - c� 8 ; � <br />, CONTRACTO��.,� �� L �N��f-�-�,/ ADORESS CITY2IP Pt�ONE <br /> pppy �lt�/Y I - � . 3 �2�-9',�/- 5'�60 � <br /> E� �. , CONTR.LICENSE# �/� �� � . , <br /> x �/�/v ��//✓fo�Y <br />€ �'f� � r, c� � a�L�� � �d.� �� �.�c <br />��� � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK i <br /> C <br /> �� . I S/�/C,(E ���^' �y _Electric �Gas_Olher / y � Q Q � <br />� ��•��,� - <br /> w't, WORK DESCRIPTION � <br /> C p /�/ S frk ��/O"/ o F /�/�� ,�'i�✓�< F �.9�v�. /\� /) LJE/:ii,��. <br /> � <br /> COl � / C - � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C—air handling units <br /> ? Bathtub � Forced air systems <br /> � Lavatory(wash basin) Gas pipi�;g <br /> Shower L_ Waler heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gas range <br /> � Clothes washer % Clolhes dryer <br /> I � Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) � Exhau,t ian <br /> _ Backflow preventer Hes�pump <br /> _ Urinal Unit heater <br /> i�_ ; _ Drinking Fountain Boiler <br /><'`. __ Floor drein Refrigeration <br /> � . i __ Grease trap _ Woodstove <br />{ , p�c _ Roof drains Other <br /> I-' �;Yf!`; _ Other _ <br /> ; <br /> I I CITY OF EVERETT LOCAL SALES SAX CO�E IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to 6e lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not The granting of a pe�mit does not presume <br /> to give authority to violafe or cancel the provision of any olher state or local law regulating constructlon or the performance of <br /> constructi�That I am authorized by the owner of this property to perform the work for which application is made and I comply with t�ie <br /> State CpMrac2ors Law 1�27 RCW and 296.200 WAC. <br /> � � � �� � � / � �� . -7 _- <br /> \O/' or . _ � / — V � <br /> I Signature of Owner/ContractodAuthonzed Agent Date � , / � � <br /> � <br />