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i � <br /> PERM�T APPLICATION <br /> CITY OF EVERETT F�ERMIT SERVICES <br /> :i200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810— FAX 425-257-8857—v,�ww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � 3 —O 6 <br /> SITE ADDRESS PARCEL TAX I.D.# �f�`�Z��t'L`'12t1 p RMIT# <br /> C; ' '` �✓�C�� `az.r <br /> G'C'.�'>'• '°� .,��, �L'r2 �ZC� Lr��- �:Col(;'"Z'C, 50 <br /> LEGAL LOTNO. BLOCK TRACT ' <br /> DESC. <br /> OWNER , , ADORE 5 CITYIZIP PHONE �r <br /> n / r / y'zs��7 G� s- <br /> jlC�(zFli�'�f%%'-:i�.J��/;i��/LUG3'�'/Q(l.l. �C:i��_/��/c1��vG` C_G�C:/�'C1T �/�" 1'-i��. �(�LrCI <br /> TENANT NAME � COHTACT FOR PERMIT ��WN �LC.�n,r�G:S' PNONEI�7S•L'SZ���I S_� <br /> j� .f�� % � T <br /> Jl(/:,iC� [/CN'if)t ��7ZU�Ct' IN�G I/L�l.�l1i�C.S 1.��/ ��A.','l,ll:> U"'� �-�X>��=-'+S <br /> C9NTRACTOR / � / ADDRESS C�TY/ZIP PHONE <br /> 'Ci�:�r-� i.;�'�'�• (_Yiv���'7'�1�crirn, � i-. <br /> �7 -{7;.3'=s�� ��i 4 <br /> CONTR.LICENSEi{ ��f,�.�ti L � "�'11 ' I `�t� �L`h� 5���� � <br /> 'C.L 1-� �� {�� ��2�Y"if""_�''?u� — <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> ��l(�y�ILr+�L Zi`(-�1Lk ___Electric LGas_Other � ���L�Z't' <br /> WORK DESCRIPTION <br /> ��Cn-iS�'zcC'�- �t;,-r� D� if��j l.C1L�(1-K� i1(1c�i% ���'t�G �cC':�� �SEi=xilrc`:�� t1"� 7:,;1•� <br /> �1 2 7� <br /> ��i-� l��,.•9t��� Il��'l�'i: ��-Cti..�.�r��� �N F_xl.`i�1t�; t�c� I����R -' c - <br /> l�Ut�L7c1.. � OiC. � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> l0 Lavatory(wash basin) _ Gas piping <br /> 7 Shower Water heater <br /> '%i Kitchen sink 8 disposal _ Gas fireplace � <br /> ' Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> _ n, Ran e houd <br /> S nk(servicefbar/mop/etc.) � Exhaust fan <br /> Backflow preventer __ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refngeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby centity that I havz read and examined this application and know the sam=to be true and correct. All provisions of laws and <br /> � ordinaces governing this type of work will ba complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating consVuction or the performance of <br /> construction�hai I am authonz by the owner of this property to perform the work for which application is made and I comply with the <br /> State Co r�Law t 827 �W 29 200 W . <br /> ,� ;, � / .� �' ', �"�.�.�_. C� I G� <br /> Sign• re of O er/ContracloU uthonzed nt D te � <br /> � 1 <br /> L ���i�'�'�>>r'r ;��% �+=cr-1,r�c_,—� `' <br />