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PERMIT .APPLICATION ��`� � - � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.ever2tt�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �r��cIC��_Ii���� C C70 J- OI�; Z-- <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �> ' ���m/.�_..� �� �v� 3`IC� 7c� 301 � c:� 3 D'l�l�- 03 <br /> LEGAL LOT NO. �J l,�' 6LOCI< TRACT OR SUF3DIVISION# �� <br /> �' '�l-I- � (� S . �5�- f-� C��;� � �s' <br /> oesc. �r; ,3. 1�, ; —� �r'c'(c L���c � � <br /> OWNER ADDRES3 CITY/ZIP PHO(�E � ��>'+�� l�t�r <br /> �- �.,`�'' = <br /> 7� : '_ <br /> c�-�, � Ucr_�c;. �..r� � C�l. ..��c �//nj l''lt �r. �r.0 Jf ���(/.. �V I�?i l " <br /> TENANT NAME CONTACT FOf:PERh71T ' PHONE T <br /> �/ j. <br /> /:. % � `..'_\ E-M 1 " n '(� . <br /> CONTRA TC 0 ���.� � ,J ��'':n- AD- /LIP P ONE <br /> " �\. ,Q�L��` ,�,� ,� / / <br /> � i�yJ��1/V`� ( yLS) Jci -l� / <br /> CONTR.LICENSE# n �� � � <br /> L,�1�1 - IQ�I(CIC / ,.�. � i� ,-, , .�,�, %y� -,� r� `��><rj <br /> USE OF BUILDING �_���7� (>�{-��� HEAT SOURCE CONI'RACT PRICE QF WORK i <br /> � , ., �/_ <br /> C 41 a n��l'� '{c� i'i rru���e r��d� �Electric _Gas_other � ��� ( /:��-� <br /> WORK DESCRIPTION . • � � �/_.,.� <br /> �{'�1ei1�C��C � ��Gl� t�'��E''�ll�i�� "�' �-e- �J�C�, -�-� IIC� �'� ����{-��G�, I�e�+ '� <br /> �J n-Z+j-e / � o f . <br /> . <br /> . �•. ' ?LUMBING ' MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF fIXTURE OR ITEM <br /> I �,Toilet � � � . �,,� , 1_ •NC-.air handling unils . <br /> �athtub � � Foiced air syslems <br /> i . 'Lavatory(wash b3s�n) ', '� � , . . � : , � Gas piping <br /> i Shower � I Waterheater <br /> � i(clicn sink�.dispo's91 ' � _ s fireplace <br /> Dislnvasher Ga nge <br /> 1 Clolhes'�•1@sher � Clethe er <br /> � Water heal?�, �_ Range hoo <br /> Sink(service/ba�r tn /etc.) � Exhaust(an <br /> = Backflow prevenler� _ Heat pump <br /> Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> I _ Grease trap WoodslovQ <br /> Roof drains Other � <br /> � _ Olher _ i <br /> -- — — � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 I <br /> I <br /> � I hereby cerilify thal I have read and examined lhis applicalion and know the same to be true and correcL All provisions of laws and <br /> ' ordinaces governing this rype of work will be complied wilh whelher specified herein or not The granling of a permit does not presume � <br /> I to give authoriry lo violale or cancel the provision of any other state or local la�v regulating conslruction or the performance of <br /> construclion.That I am aulhorized by the owncr o(this property to pertorm the work for which application is made and I comply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> l.' l� L� 7 � <br /> Signature of OwnedContractodFluthorized Agcnt D9te I <br /> ��� - — - -- - - - ---- — - � <br />