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� <br /> �rc� �'�� % <br /> � <br /> PERMIT APPLICATION -� <br /> CITY OF EVERETT PERMIT SERVICES a�oy�boCb2c� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-25'-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4� <br /> SITE ADDRESS � PARCEL TAX I.D.# l PERMIT# <br /> ��� ���,���� �'u��. s���� - � ��S- �i� <br /> LEGAL LOT NO. BLOCK TRACT OR SUB IVISION X <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE � � <br /> �c-�i'2� - _i-F�s, D.o.S. �(25 33"1 �c�� <br /> �LY�-ZS �I�t�' �c.�C�C, �7cc C�L-Y�t-�, `I��[;%Yi <br /> TENAN(NAME CONTACTFORPER IT HONE <br /> G,<<�:_o f�cniTa� S��.e.c.�, lac.. �ZYn,� Eti��i�t��.a�-S L�ZS� Z$Z� i-� �3 <br /> �c.�� ���LLnI-�V..n✓.r�� . c�2` �J'�F;'�L3j 2�.�2 �\�1C.1-ii[[.1:� E-MAILr'-':�an5('� Zf:�2rb7�,liR"G,?i�l �_L'.(.l. <br /> CONTRACTOR/�, ADDRESS CIN/ZIP PHONE � <br /> �T�'�N�-`( O�J��,C�pi�: <br /> CONTR.LICENSE# <br /> USE OF BUILDING / HEAT SOURCE CONTRACT PRICF OF WORK <br /> rp�c� ti«O�c•�� <br /> GL�a�[, Electric Gas Other <br /> — �c. — 3� so� <br /> WORK DESCRIPTION <br /> �;C�J�'�6�;t'-�c,�/ t�� l..'L'Ci �F� IC.I" '�' �'�..'r�= !V(:.i ✓i"J �i'C/L .�t7v���LLl�QJ(c�'1'rG�-�� C�d�. <br /> Iti�c.c ,.�c5 ti'i:w� D��i�r:SiNF- �.��c ,� r�o�' � �'1iL[cn��cti: �r`- �-Xi�iriJ� ���(nICT`�� <br /> I' L C GL1t'�ji ni�o '�/ K(L'.2L�) L hic� TEtJ hnJ'� �fkCE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet FVC—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Unnal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrige2tion <br /> Grease trap Woodstove <br /> Roo�drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certity that i have read and examined this application and know lhe same to be irue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether speci(ed herein or not.The granting ot a rermit does not presume <br /> to give aulhonty to violate or cancel Ihe provision of any other state or local law regulating construction or the performance of <br /> conslructio That I am aulhorized by the uwne`r of ihis property to perform the work(or which application is made and 1 comply with ihe <br /> State C nTr�ctors Law 1 �27$' and �00 WAC. <br /> �, i <br /> Zf l� �.�' .�['L:- �T�'�- .Sf !Li <br /> 'ignaWre f OwnerlContractodAu�hO .ed Agent D � <br /> / (Z. <br /> I �7 <br /> �c'� '.' � l c r,i.t�/�(Fi( ;S � i/ L %7/�('i�I! 'i2�C i�-:/.�_ <br />