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. , _ � �_ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ` �7� �� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT• <br /> 1 O� VP✓' �e w . U' G SlID / - 00 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CfTY21P PHON <br /> Gt���w� j3� `I�c � l/�U`,2 El/P� �o�i Ga�U�L:e7f' <br /> TENANT NAME CONTACT FOR PERM PNONE L,Z�' �Z� <br /> 7-���,e-a,�s,QN���,.yu� �o�y <br /> c�[ t�,.K f3►a R�� k �i u�-t ✓vt ��n a►2 E�+N� <br /> � n <br /> "�fFSrQ�t ��c�r✓�-�/ �/S �� gT 1�rkL..wJ/ �'22 f2�u <br /> �C NTR.LICENSE M ( NL <br /> i�.n �:�..a[- m�o J 13 �Sn3� <br /> US OF BUILDING HEAT SOURCE CONTRACT PRICE OF�WORK <br /> v <br /> �-.�a� k _Electric _Gas_Other ���! [U� <br /> WORK DESCRIPTION���` � S-��tl ��P S!Q✓J�S�Q� • /u5 /�[� � -�L`{"7 <br /> c�wtitiv� L� s �q,� /.�c���..� t47v� s�' l T��,4<<' 3 t�'1� <br /> ,l�rveuP�cc�,.fi ?'rafF�ccoNlv�+ [lc�y^srq,,�s� 6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FU(TURE OR ITEM <br /> Toilet NC—air handling units <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 /> Ciothes washer Clothes dryer <br /> 1Naterheater Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodstove <br /> Roof dreins Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give authorily to vioiate or cancel the provision of any other state or local law regulating construction or the peAormance oi <br /> constru lion.Thal I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br /> State ntractors L w 1 .27 RCW and 296.200 WAC. <br /> /6 � '1/i:� C� <br /> � Sign ure of nerlCo tractor/Auth nzed Agent D e <br /> I/ <br /> � <br />