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����) �� �C� C�, �i '�;�:` �`-'�;��� PERMIT APPLICATION ��I a,�;G ��G��u�-� l� <br /> ; � ��` � ; �. �,� ,, �C��TY OF EVERETT PERMIT SERVICES (���L f l��G�r <br /> �"� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> CITy pr EVEitr_I I <br /> n ;,.' ; ''r�tiFubliC SENIcBS APPLICATIONS ARE ACCEPTED FROM 8 AM T0 4 PM � `�6 � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��� � �a�� �-v� (����- a �vo s'���.�2 <br /> LEGA LOT NO. BLOCK TAACT OR SUBDIVISION 8 <br /> DESC. ' <br /> OWHER pDDRE55 CITY/ZIP PHONE <br /> �i�r� Wichn�-�1 5��z5 IZ�ti Rvt G�, �l�lffl� �'l,�r�H �I�Z� �l�yo7-lao� <br /> TENANT NAME � ONTACT FpR PERMIT� PHONE OV�� /�� J�� <br /> � f� ��L�CG VJCU�I��S E•MN�OfWa��� (TLC � �I <br /> cQLUFlSNIIu'GrTO� w�TE2���ADDRESS I�,�`�I ���, c I 21P PHONE i(if�/'�.�y_ U7� <br /> aQW� � J W 7 /Oo <br /> CONTR.LICENSE ��"` �� ��Q <br /> �a��sr-�r�� y�o oP /���evuc G�JQ 9�a5 <br /> USE OF BUILDING �� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �/���'I C�yvU l _Eleciric �Gas_Other ����" <br /> WORK DESCRIPTION c'�� J <br /> �'�l'���,'�1� C,�}�-� G�(� I �'�i���'� ���il,l.�ii <br /> PIUMBING MECHAPJICAL <br /> N0. TYPE OF FlXTURE Uk ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilei NC—air handling uni�s <br /> Bathtub �orced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower = Water heater <br /> Kitchen sink&disposal __. Gas fireplace <br /> Dishwasher Gas ranc�e <br /> Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/badmop/etc.) Exhaust lan I <br /> _ Eiackflow preventer _ Heat pump <br /> _ Urinal Unit heater I <br /> _ Drinking Founlain �oiler � <br /> Floor drain Refrigeration I, <br /> � Grease trap Woodstove <br /> Roof drains Other � <br /> Other <br /> I <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicatiun and kno�.v the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether speci(ied herein or not.The granting of a permit does not presume <br /> to give authority to viola�e or cancel the provision ot any other state or Iocai law regulating constmction or Ihe pedormance of <br /> conslruction.That I am authorized by the owner of this property to perform the wprk for which application is m�de and I comply wiih the <br /> ,-Stat Cont afclo�;rs1 w 18. 7 RCW and 2�lb�.200 WAC. / <br /> ���' �q ` l.l,l.� � �. /��.u-�C�'� C�JI��/�f ' <br /> 6 ! <br /> $7gnaWre ol Own /ContractodAuthonzed Agent ate <br /> L�� <br />