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- —� -- <br /> PERMIT APPLICATION <br /> '� CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �I <br /> 425-257-8810 - FAX 425-257-8857-�vww•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a.�-17-p � <br /> SITEADDRESS I PARCELTAXI.D.# I PE���nn u2� <br /> tl L <br /> �c�i.� �3 , v� v . � � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBD�VISION p <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE (�{�f� jcj-`I_�`j <br /> �� (, i > � <br /> I—� '�`�l�'r ��L�!'� �C I�/t��71��'i , S�'�2 �_'�7��� �6�e. l� _ L`1,'C�v^Q,� 9C��U 7 <br /> TENANT NAME i CONTACT FOR PER�AIT PHONE <br /> ���I��i(� �''-`� �'I�i1C'_v � >Ci�i��e Cl5 �Gvf�N.�. e•rnni� Ki���C�St����i���G�C �cSf }. <br /> CON�RACTOR ADDRESS CITY/ZIP PHO E ���'�I <br /> ,�run����c� I��s1"r�� � z ;-• It�-C,.+- It�✓y 2`� �' � , � � f (4z5 ) '145 <br /> CONTR.LICENSE� 5�.��rc 1 c i y �{p r,,��� `� �- 597��_ <br /> A h ��A r� ��� c�:33 l?�.i <br /> USE OF BUILDING HEAT SOUFiCE CONTRACT PR�E OF�VORK <br /> I� ,. � { _Eleclri; ��Gas___Other ���� - �-D�J <br /> ��. �� (-�>l �C=ti � <br /> iWORK DESCRIPTION <br /> � 1=�. fe �.(� �Zll`� (�L�� �tiv �lt�� ��Yt��:,� . <br /> i <br /> - P�UMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEPd NO. TYPE OF FIXTURE OR ITEM <br /> Toile� __ A�C-air handling units <br /> Bathtub _ Forcetl sir systems <br /> I Lavatory(wash basin) ___I__ Gas piping <br /> Shower _ Weter heater <br /> � Kitchen sink&dis, �sal _ Gas fireplace <br /> � Dlshwasher Gas range <br /> Clothes washer _L Clothes dryer <br /> Water heater _ Ranc�e hood <br /> i Sink (serviceibar/mop-etc.) _ Fxhaust lan <br /> � Back(low preventer ___ Heat pump <br /> � Urinal Unit heaier <br /> Drinking Founlain ,___ Boiler <br /> � Floor dr2in _ Refrigera�ion <br /> ! Grease irap _ Woodstove <br /> 'i Rool drains Other____ __ __ <br /> li Other--- - _ -- ----- --- <br /> _ . <br /> I -- - <br /> — — -- -- ---- - <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II <br /> I hereby ceriU(y that I have read and examined this application and know ihe same to 6e true and correcL NI provisions of laa�s and <br /> '�, ordinaces 9oveminc�this type of work will be complied with whether specitied herein or not. The granting of a permit does not presume <br /> I to give authority to vioiate or cancel the provision of any other state or loc�l law regulating consvuction or the performance of <br /> � construction. That I ar�authorized by the owner of this property to per(orm the�vork for�vhich application is made and I comply with the <br /> ���. St2te Goni�ac ,5 w 1827 RC and 296200 W AC. <br /> . � �� � � � ��,� ���. , �� <br /> � - <br /> . Signature of OsvhefCo t�ra`ctodA horized Agent Date <br />