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� ( i <br /> � PERMIT APPLICI�►TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /���`�;� —�� <br /> SITE ADDRESS PARCEL TAX I.D.p ��PE,R,M�Ij M <br /> SJoi 23`� 0��J. 31c�� /l S�ti�� �G� ('� �.l C���i� CJ �JI�T_ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE <br /> ( C�;� 1�0�_ �C �1c32 � �� ��. < <- <br /> �c��:���.,��.� � . / � S� Sr.- e I�iiS <br /> TENANT NAME � CONTACT FOR PERMIT PHONE�L,. � �y_3/j � <br /> /V�I�G�y�i'utY ��,. . ( I�C� /[<v� .�/CYI�'S E�MINL /'"�._tfyC'�l�v'11J���1.�/1 i�C.�k.i <br /> TRA 8��� (- �b -7 1� �// ,/ cso (/ <br /> �V'✓'4fOli,�. �L.-1./��,, ��r_�.ti. ��7 .� ,Cf�✓t J•� .Sf- �l.��Lt'- G✓I' / :J/�.�J <br /> l ,� <br /> CONTR.LICENSE# �VC/GGI�L�I-5 ���� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I _Electric _Gas_Othei I �j /5 � �� <br /> WORK,DQSCR�PTION � !, / � <br /> f ti�Gi D� ��L�j C'�. �l� �' /����'j a`- t�v� •f--�w S <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FI%TURE OR ITEM -- NO. TYPE OF FI7(TURE OR ITEM <br /> Toilet � A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishw2sher Gasrange <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) � Exhausl fan <br /> Backflow prevenler Hea�pump <br /> Urinal / Unit hea[er <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOC/LL SALES 7AX CODE IS 3105 <br /> I hereby certify thal I have read and examined this applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing lhis type of work wiil be complied with whelher specified herein or not.The granting oi a permit does not presume <br /> to give aulhority to violate or cance�the provision o(any other state cr local law regulating construction or the per(ormance of <br /> construction.That I am authorized by ihe owner of this property lo pedorm the work(or which application is made and I comply with lhe <br /> State Contractors Law 18.27 RGW and 296.200 WAC. <br /> �I�slio <br /> Signature of OwnedConlractodAuthonzed Agenl Date <br /> �l2 <br />