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\ <br /> .,� ��.��'w ���La _ - -- ----Z�2-7�� -- � <br /> i �-�u . <br /> j I �(��:�����.� l�J�i�.�:�-� I�ERI►JIiT APPL.lCi�Tl01�1 I <br /> i CITY OF EVERETT PEP,MIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8557-www.everettwa.org � <br /> i <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� � z�pg <br /> �� SITE A�DRESS PARCEL TAX I.D.:! P,ERMIT:j I <br /> u��� ��tr- ?� �.� ry� 2 �`� � o ��i��, uov�o--�c�> � .'M z( 1 � ' r?o(v � <br /> LEGFU. LOTNO. � BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITYlZIP PHONE '� <br /> i <br /> 1M0.c��r� �t": .�a�lC�. �`cv�Sl� \O�t» \l4�" P� `-v �,��{+ `1`S Zv-���-z 5) `��`1 'Y��SG� <br /> f TENAN7 NAME CONTACT FOR PERMIT `PHONE — <br /> � I �. � � .�� L-l_�,-'--l.Js��i - CCJ O-�1�c- 8'.`j,5� <br /> CONTRACTOR ^ �/-- ADDRESS z , � ( �i � �CITYlZIP PHONE �, <br /> � ' <br /> ii.�Rs,�,�vi�rz�� Gv'-r� �;,;�., ; lfi�c ��;�� — I <br /> �L<«�kL�Zy -� ���/'u/��t�, j� 5'y��p�; �� <br /> CONTR.LICENSE# � <br /> �/ �/,. �' ?,� � <br /> i cc-95�d1�x-`%����%�r � i I <br /> USE OF��ILDING- I � HEAT SOURCE �rt CONTRACT PRICE OF WORK !, <br /> II�i �-� _ElecVic _Gas_Clher °� �'q� <br /> li WORKDESCRIPTION � ) ,f��L�r�C �L���''� ��'�' �� <br /> C.��'L1 Gk.� (n[�i� �I � <br /> 0- <br /> � i <br /> I — PLUMBING MECHANICAL II <br /> ' Idp. TYPE OF FIXTURE OR ITEM NO. TYPE OF RXTURE Ok ITEM <br /> � Toilet A/C-air handling unds II <br /> �� 6athWb _ Forced air systems � <br /> Lavalory(wash basin) _ Gas piping i <br /> - Shower _ Water heater � <br /> ��, Kiichen sink&disposal _ Gas firaplace � <br /> '� Dishwasher Gas range , <br /> �� Clothes washer _ Clothes dryer ! <br /> '�I Laundry tray _ Range Mod • <br /> � Sink(service/badmop/etc.) _ Exhaust fan � <br /> � _ Backllow preventer _ Heat pump � <br />; 'il _ Urinal _ Unit heater i <br /> _ Drinking Foun�ain _ Boiler I <br /> Floor drain Refrigeration I <br /> j _ Grease hap _ Woodslove i <br /> IRoof drains __ Other <br /> = oin�� CJccLc� �,.,L�.� _ <br /> I CITY OP EVER�TT LOCAI SALES TAX CODE IS J105 �I <br /> I hereby ceritify that I have read and examined this application and know ihe same to be tr�e and correcL All provisions of Iaws?nd �I <br /> i ordinaces goveming this type of work will be complizd vnih whether specified herein or noL The granting of a permit do�s not presume , <br /> � to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of i <br /> �, construction. That I am authorized by ihe owner of this property to perform the work for which application is made and I cemply vnth the <br /> � State Contradors Law 1827 RCW and 296200 WAC. '�. <br /> �> -Q_ �U-�.S�=v-� at'"L�-OC,� I <br /> w I. 5ignature of OwnertContracrorl iori�ed Agent� Date T� <br /> I <br /> _ ._ _ - - - ._ . . -� --- _ ._.. .. .._ __ . _.._i <br />