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( i <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org y —q '"�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM M l UO y"��J <br /> SITE ADDk[SS ` PARCEL TAX I.D.M PERMIT N <br /> S�l .23"` .���. �J � ��Ko2�o�o��ov - Z <br /> LEGA LOT N' BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> �JLc�wr�.� (',�.��r���_-f-� �.vt 3C �/13Z �t/c 9�f` S t' S'G�:-C'f�e. �! �//S" <br /> TENANT NAME CONTACT FOR PERMIT �HONE L UG � L 'y�3/3�% <br /> ` �7 , / i �(, <br /> f�Ll,�a-C /l�f C�U ��`��,�' `�����' E�NIAIL Y17�,t�{i F✓E[/t���lln�;�c. ' <'..: <br /> ���ft�—L ✓<':. �.�tin 12<�. ��C'�._. i,,.tiE ;�2 � `.�' /��nyr.�� / <br /> �� �?�:..L�-f(G/Q�SlUfi �.x, 7�S.i7v% <br /> CONTR.LICENSE p <br /> EVG 2Gr21_ 95�1 ,Z Z <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Electric 1�Gas_Other �7(�D�j <br /> WORK DESCRIPTIOk <br /> +� �- <br /> nu/1 Cl:tS P��i'.�.j, �-i�M iYle:�N✓� /•'I�L Cw'�..� {�Gfr 5��4c% +'�Jf �-��/C_ t.(y. <br /> i/ � <br /> ��uw ?r/ i;.-�e) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OF ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeretion <br /> Grease lrap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify that I have read and examined ihis application and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granting of a pertnit does not presume <br /> to give authorily to violata or cancel the provision of any other state or local law regulating construction or lhe performance o( <br /> consiruction.Thal I am authorized by the owner of this property to per(orm the work for which application is made and I wmply wilh the <br /> State Cor7tract s Law 18.27 RCW and 296.200 WAC. <br /> � // <br /> !✓i,�— ��,3=� 7 ��/U <br /> SlgnaWre of OwnedConiractodAuthorized Agent � Date <br />