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'� �- �—o S <br /> P�RMIT APPLICA�'ION ��,�,,,�, <br /> CITY OF EVERETT PERMIT SERVICES �l_n ��/ <br /> 3200 CEDAR STREET, EVERETT, �N^. 98201 �L�J'� �1 ��7 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org � <br /> ,�03-/ Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT�CREDIT CARD5 A E NOT ACCEPTED <br /> SITE ADDRESS PARCFL TAX 4D.p PERM # <br /> � 2an'� - �90 -, o�to-b4dD 28as -�9 - � . , <br /> 1 I � Gv2V'G pgp -o3nr�/�4aS' -1qo-a�+b- o�» �J�� ��/� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER C� ADDRESS CITY2IP PHONE <br /> L'p , S� Sr,rh oP, .�S�okclQ� �•�. PD.BOX 52G��1 Ev.tu�C.��l.v/� `f'� � 2�2- S�� <br /> T[NANT NAME CONTACT FOR PERMIT PHONE <br /> ►� �� ( r a rGh��ar ��LP.�1w1 �'Z5 - 25� � 3( (�� <br /> CONTRACTOR ��, G '}1��� • h Q�A DRESS CITYIZI� PHONE <br /> J� <br /> CQNTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.(�(l I / D`/`u/A s�� _Eleclric ✓ Gas_Other � C�j�Q + Ql�Q <br /> �� <br /> WORK DESCRIPTIO <br /> 'Dt�e�is�, eXl�s�iL� �� �.1.�1!� �,ln� cE�vlS�e��" lnP.�J I� , 035 S'� <br /> �'kE'�� �a �`F� 2 . � <br /> i <br /> LUIIA8ING MECHANICAL <br /> NO. IYPE Of•FIXTURE OR ITEM N0. TYPE OF FiXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub � Forced air systems� <br /> 5� Lavatory(wash basin) �� � � Gas piping � <br /> � ,Shower �_ Water heater � <br /> _j� Kilchen sink 8 disposa�/ � Gas firepla� <br /> D'iShwashar / \Gas ran e <br /> _ Clothes washe j _ CT h dryer <br /> Laundry.iray Ra hood <br /> _j_ Sink(sern c/bar/mop/etc.) � E aus�l�an <br /> BackFlow,p�venter ,, eat pum <br /> I Urinal/ _� Unit heater <br /> �_ Drin�ng Founla\ i Boiier <br /> Flaordrain \ �� Refigeralion <br /> Grease Irap \� ; _ �Whedstuve <br /> � Roof drains � _ <br /> Other <br /> _ —I <br /> LITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify lhat I have raad and examined this applicalion and know lhe same to be Vue and corred. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with wfether specified herein or not.The granting of a permit does nol presume <br /> to give authorily to violate or cancel tne provision of any other state or local law regulating construction or the pe�formance o( <br /> construdion.That I am authorized by the owne�of ihis property to perform the work for which application is made and �comply with the <br /> Stal Coniraclors Law 18.27 RCW and 296.200 WAC. <br /> d , ,Kt ' \ U dA�l. 3 � a 'r , � <br /> Slg�n ture o(OwnedCoNraclod uthonzed gent D�te � <br /> �` <br /> J <br />