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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA f�8201 <br /> 425-257-8810— FAX 425-257-8857—www.eve�rettwa.erg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIr 0 <br /> S1 UI �3��' �Dr W �` /U3 �r�J �c;';�CX�;�C�C) ��d�J � - <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER A:DRESS CITY2IP PHONE <br /> -, - / � 7r / / o <br /> ��C'GiI..J�i � ��;r!' �L�l )L. L�(� � ��.L /vr Q;�f[` St S�'= � P W� %u// <br /> TENANT NAME � � CONTACT FOR PERMR PHONE 2Uc.� C>77-3�3�'l" <br /> ���Vi.n��r�� V�.,(i.>�' �'�'c.�-- I �`v�/]��c:c.`rf E-MNL�"�.:�bf.JCJ✓.'I+�rPt..�(� .c.; <br /> LrdNTFFA T4PYi�HbAE--' <br /> �Vt2C5 i7EE,✓ ZEFRiGE2..Ft���l 9.� ? g. ��r, >� cJ�_it/C 2oc,_7G.5/¢�>�/ <br /> CONTR.LICENSE# 'LV_ICG-2G�/S�/)Zh <br /> USE OF BUILDING HEAT SOURCE C'JNTRACT PRICE OF WORY. <br /> _Electric �Gas_Other �j ��� ��� <br /> WORK DESCRIPTION p I1 /� /� . <br /> ,�/'�5{4�� a,�z {ZTLI. C..xl.0 �� ��;��^�- � I.��I� W•II bc:- ��c.�nJ'r �C �n ���i.l. Ot 5c/'r�rm�n� <br /> G�S Lic'c�c��rct }o� •��mif /�(IUOC� -0�2 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TIIRE OR ITEM <br /> Toilet / AIC-airhandlingunits <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _�_ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Foof dreins Other <br /> Olher <br /> CI7 Y OF EVERETT LOCAL SALES SAX CODE IS 3�05 <br /> I hereby certify that I have read and examined this applicalion and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting o(a pormit does net presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaling construction or lhe pertormance of <br /> consiruction.That I am authorized by lhe owner of this property to per(orm the work tor which application is made and I comply with the <br /> State Cont bClors Law 18.27 RCW and 296200 WAC. <br /> �:/fll,_-�'n,_..� c,/�s/� <br /> Sig ature of OwnedConlractor/Authorized Agent Date 1�� <br />