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PERMIT APPLICATI(��� <br /> CITY OF CVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> ���j1� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT# <br /> ���' ��., j� �i�f'_. �GF)���J������;�O�CCJ7�l)(YJCC(���o9-3� <br /> LEGAL LOTNQ. BLOCK TRACT <br /> oesc. � �... � � - . ��y T I .C; <br /> OWNER ADDRESS CITY2IP PHONE <br /> 1��', 01� o, C�r�'�zc�V ��3 ��n�'� 5-1- Si,w Lv���it 9�c:z`-I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �kt��� ��=�',i- /1s-i�tv�r.�� Altr�n�/�lL'��_Ei� n��, �uz�il(�7��-�70.� <br /> CONTRACTOR,� ��KiY�Y1L'� G(ciC�� ��C, ADDRESSr-� �r ����'� CIN21P PHONE �C(p. (o�,q, � <br /> . S2a$l� �sI2Z <br /> CONTR.LICENSE# � -, � <br /> ����:�,�1�►����z � Z�y.�� <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF WORK <br /> 6 _Electric _G2s__Other ���� �(y�� <br /> WORK DESCRIPTION <br /> /UQ.�'J �61�4��riC1' {��l('�1�1G�'�� r Vl<.�U (�.Ir�'1�iSl Y'1✓� lnA_�� � {�ICC[J C�G'C";r5, �LQC.CJ ��Q51�'(XjV�Y15 <br /> Iv�tii2( y�Yt(�r�11 ��v��;civ�ncC.��-1� �,,� �-{'t��5 ��Xc2. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi!et A/C—air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wasn basin) _ Gas piping <br /> Shower Water heater <br /> Kilr.hen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater _ Range hood <br /> Sink(service/bar/mop/c�tc.) Exhausl fan <br /> Backflow prevc^ter _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Soiler <br /> Floordrain I Refrigeration <br /> _ Grease trap _ Woodslove <br /> Roof drains � Other <br /> = Olher I = <br /> CITY OF EVER^_TT LOC��.L SALES TAX CODE IS 3105 _ I <br /> I hereby ceritify ihat I have read and examined this ap,licalion and know the same lo be true and correcl All provisions of laws and I <br /> ordinaces governing this type of work will be complied with whelher speci(ied herein or noL The granting ot a permil does nol presume <br /> to give aulhoriry to violate or cancel lhe provision ot any other stale or local law regulating conslruclion or the performance of <br /> conslruction.Thal I am aulhorized by the owner ot this property�o perform the work(orwhich applicalion is made and 1 comply with the <br /> Slale C tractors La�0.27 RG' and 296.20D WAC <br /> / " _ '� �% �Z� <br /> Sign re o wnedCon acl r/Aut r'z d Agent Date � ` <br /> 1 '�� <br />