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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 320G CEDAR STREET, EVERETT, WA 98201 <br /> /� � j 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> C N��'f2 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��(�.�j��(��,/� <br /> SITE ADDRESS p2.yl . . PARCEL TAX I.D.It PERMIT k <br /> ��-7 � #� �v�s�r- ao�3piy�B���oo CG77/2 -0/Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. �7i,�g 5L86d-oa�' EG52[�j- ,vG�— <br /> OWN':R ADDRESS CITYIZIP PHONE <br /> ,� <br /> .(�Mv�hw r�. /l�arv...' `fy1-5_ 2� �J a�� �r/ ��-e.�r1-c `�k'-�'j i'ry'3�i"-3`7�� <br /> TENANTNAME' CONTACTFORPERMIT PHONE <br /> ° `ti"'�'� L�i�`;�l S���j� <br /> CONTRACTOR ADDRE55 CITY/ZIP PHONE � <br /> .1 <br /> CONTR.LICENSE N `,� ` : � <br /> �b l i �CJ/�-,�/ <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> _��jc` 'S�� _Electric Gas_Other �3�� 23 D^ �/,S-F <br /> WORK DESCRIPTION � <br /> COrYsTi��T" A/vGt� bva��X '>`> 7�Z V�'=� :-j�'� i .. '., <br /> , <br /> — -1 ��= C'7 �Oj <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,- / Toilet A/C—airhandlingunits <br /> `� � Bath�ub � Forced air systems <br /> Lavalo;y(wash basin) Gas piping <br /> Shower Water healer <br /> Ki�chen sink 8 disposal %Y Gas fireplace <br /> � Dishwasher �� Gas range <br /> Clolhes washer ti Clothes dryer <br /> Laundry tray � Range hood <br /> Sink(service/bar/mopletc.) O� Exhausl fan <br /> � BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove I <br /> Roof drains Other <br /> � Other ��s�l�� �jt!Bp — — <br /> i � <br /> CIT'OF EVERETT LOCAL SALES TAX CODE 151105 <br /> I hereby ceritify thal 1 have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces 9oveming this type of work will be complied with wheiher speci(ied herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the proviaion of any other state or local law regulating construction or the performance of <br /> conslruction. Thal I am au;iorized by the owner of Ihis property lo perform�he work for which application is made and I comply wdh the <br /> State Con�ractors I.aw 1f127 RCW and 2962001h'AC. <br /> �� � <br /> ' (.,tav�r .�/U !�%"�l-'�-� � z-j1r�p '� <br /> Signature of O�v rlCoNractodAclhorized Agent �te <br /> ----- -------- ---- //� <br />