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n <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES ,' <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-A810 — FA.X 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />SITE ADDRE55 PARCEI. TAX I.D. p <br />.�,� ".J rl` i��%��)'^ �� ��-t �O�( 2� � �`I �� <br />LEGAL LOT NO. BLOCK TRACT �./. <br />DESC. �/ - ! , � V�L.''C /1 Ifa�� L'I <br />OWNER � ADDRESS <br />IJi7�- �,� L�CL-,� :: � >nG�Cr..1h J/20 /L�CiJD'1cY.t%� <br />v <br />TENANTNAME �� <br />1 Cr^�✓ncr�.rS'� <br />�,.1n�.iCC, WGJ,1 GF �.J���t�{ <br />CONTRACTOR � <br />I'LIc�C I)C'�C.�C1 /)ll���: <br />CONTR. LICENSE t <br />Mrk:�oF s `1�,�• :=v <br />USE OF BUILDING . I <br />,� <br />\ _ , ':n .'L��, r' � L i.�..` <br />WORK DESCRIPTION <br />cicic.� '7 _u��fc�-,r.' � <br />I'i^isC c��C F w .�.-� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />_ Dathtub \ <br />_ Lavatory (w�a h basin) <br />Shower <br />=Kitchen sink 8 dis sap I <br />Dishwasher \ <br />Clothes washer <br />l aundry tray <br />Sink (service/badmop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />_ Roof drains <br />Otner <br />/iJJ <br />C C <br />CONTACT FOR PERMIT <br />�'2.r�{1 �+�c�C' Sen <br />AODRESS <br />�7�1 >�}l:-c�l �Lv� SU� <br />��_ �,i-�'l <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />C.•'1P � J: � �iQ. <br />�� ��/r,.,�S. <br />PERMIT # <br />�c;lo ) -o <br />5 i r� o. �1d �$/o��t' <br />F..��-�µ; %�� a �Loi <br />PHONE <br />(,�W) ��ss - ya �� <br />CITY2IP PHONE <br />Seca�G� "1bi0G <br />l��-)7e�-yr��� <br />CGNTRACT PRICE OF WORK <br />��� � � ol 3, v � <br />�E'��c ��'e ( d� f'F�� <br />NO. I TYPE OF fIXTURE OR ITEM <br />A/C - air handling units <br />Forced air s��slems <br />_ Gas piping <br />Water heater <br />_ Gas fireplace <br />_ Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />�_ OlhOf_.7�.�`r_4:.:i /q�.�L�i <br />/ v <br />CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br />I hereby centify that I have read and examined ihis application and know the same to be true and wrrecL All provisions of laws and <br />ordinaces goveming this type of work will be complied with whelher specified herein or not. The granting of a pertnit does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the peAormance of <br />consln¢tion. Thal I am authorized by the owner of lhis property to perorm ihe work for which appliwtion is made and I comply with ihe <br />State CoMractors Law 1827 RCW and 296200 WAC. <br />�` I`� <br />. -,� J '•� : _ ' —= t\ � <'�7/�� \ cJ - 1 �; ' �:J � <br />D -0li <br />