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�� <br /> � <br /> � � ;��1 <br /> �,��' � ,'.�K ���PERMIT APPLICATION <br /> ,;�� b ZS CITY OF EV�RETT PERMIT SERVICES <br /> . ,- i ' Z 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �` 1� 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> \` I APPLICATIONS ARE ACGEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.t PERMIT X <br /> C ^" ' rj �'�L <br /> 1 > <br /> � ����1 ��DLr;Y ll� ' � G ,a . <br /> LEG LOTNO. �BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PN6NE <br /> � (� <br /> ll1'i � �`''�'ilY.1L 2�1��[ � ''LC;;� /�G�' Si'"/'=C � �t%Z��71� %li ��L <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> l i��I°_�I�� � YF911/J��i�is' �l - 50`1� ��I- G��9�o <br /> ONTRACTOR n ADDRESS ^ CITYRIP PHONE <br /> :��71�rf��ll_ � �J�I��t�l,t/s� 2�2:P�G/ .�:� �_'�/�r>G Sr y-ls�D,ld� �� ' l��-��'yP <br /> CONTit.UCENSE/ <br /> A/IL'ti.IANLrL�/�'�Q1� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ��i11)) Irl���� //%l � _ElecUic ,p.Gas_Other `�� f�� ��, ��1 <br /> WORK DESCRIPTION <br /> �NyIT>'LLr DI�J Ov' �LF ' ' i � ✓ '1) l 1l.'/�J lr/� ��c-�%> <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUFE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet � AlC—airhandlingunits <br /> Bathtub _, Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _. Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmopletc.) _ Exhaust tan <br /> BackBow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Orinking Fountain _ Boiler <br /> Floor drain Refigeration <br /> Grease irap _ Woodstove <br /> Roof drains _ Other <br /> Ofher — <br /> CITY OF EVERETT LOCAL SALES TAl(COUE IS 1105 <br /> I hereby ceritify that I have read and examined this application and know the same ta be true and wrrect. All provisions ot laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granlirg of a pertnit tices not presume <br /> to give authonty to violale or wnce�Ne provision of nny other state or lowl law regulating construclion or the perfortnance of <br /> wnsWCi�n.That I am authofizeJ by the owner ot this property to perfortn Ihe work tor which applica6on is made and 1 comply with lhe <br /> State ConOactois Law 1827�R/CW and 296200 WAC. / <br /> I j� I �^� / �1� . � . C`.�_� %�! �1�/' <br /> g u�o ner nt�ador/ ut onzed Agent ate <br />