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_ _l <br /> PE�MIT APPLIGATION <br /> CITY OF EVERETT P'�RMIT SERVICES <br /> 3200 CcDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org // \ <br /> qPPLICATIONS ARE ACCEPTED FROM & AM TO 4 PM �D -���J �J <br /> SITE ADDRESS <br /> PARCEL TAX I.D.# I PERMIT# <br /> 7 � r. y.� r't� n\ � U� l,' Ci� <br /> 3"� � L.o,>ivc, � � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDR[SS CITYIZIP PHONE <br /> , . , �, _ �c, �X �,���� y�;��� ����,-> ��r, �y�f. ���� <br /> ���,,;,,��,-, l��aG ft <br /> TENANT NAME I CONTACT FOR PERMIT PHONE (fys ?�) ��g�,r� <br /> ��/'Rr ( C(i`��I C�II � 1 �'C'�IILsY• I�LiL�� �CLIYFJIcZJ c� �/UH'./�nGu�tf7 E•N7AIL �;ol�lc�.0l�Gtav��t�rbw� <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> /� <br /> CONTR.LICENSE# �����.f.����.j� ��T��� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I _Electric _ Gas,_Other ���� ��i� <br /> WORKDESCRIPTION � � � � ����. ���,j���/`��,".,� <br /> �<i.�C(i1� I"C�'� CCGY�L �a� �IY['RCilG:ai�E N.. .S�b� r'avLtL2 L•M...L DL C.l .ae- !f n ]�`C' "^I <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> l�/C–air handling units <br /> _ Toilet Forced air sys�ems <br /> _ Ba�hlub Gds piping <br /> Lavatory(wash basin) — �/�/aler heater <br /> _ Shower Gasfreplace <br /> _ Kitchen sink &disposal Gas range <br /> _ Dishwasher Clo�hes dryer <br /> _ Cluthes washer Range hood <br /> Water heater Exhaust far <br /> _ Sink (service/bar/mop/elc.) Heat pump <br /> Back(low preventer Unit heater <br /> Urinal goiler <br /> �II _ Drinking rountain — �efrigeralion <br /> , Floor drain Woodstove <br /> Grease trap Olher <br /> � Roof drains — <br /> Other — <br /> � <br /> I� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 _ <br /> li I hereby certi(y that I have read and examined lhis application and know ihe same to be true and correcL All provisions o(Iaws and <br /> I ordinances governing this type of work will be complied with whether specifed herein or not. The granting of a permit does not presume <br /> � � lo give authority to violale or cancel Ihe provision of any other state or local law regulating consVuction or Ihe performance of <br /> � conslruction. That I am authorized by ihe owner of this propeny lo perform the work tor which applicalion is made and I comply wilh lhe <br /> �i State ContractDrs Law t 27 RCW and 296200 WAC. <br /> �t,l�-=./�-l�'�_�-- r�. / <br /> 1 t=�7� .�V-,{�(�,�. :: r ( jC__ %, /U �. <br /> �' Date "' <br /> � Signalure o O��vnedConlraclor/Authorized Agenl �� <br /> I – _ , <br />