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--�,1U — ��C�C.� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—�w+w.everettwa.org <br /> r- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -a b -� <br /> SITE ADDRESS _ PARCEL TAX I.U.# P�RMIT A <br /> �1�0�3 Vieu� �-ves-� ����' 0o5�1� tUUJ.vIUOI ��lU� �U <br /> lEG LOTHO. DLOCK TRACT <br /> _ <br /> DESC. � _V OC'_ J�E�i�;lC-�L.�' i�C-r(a {/li <br /> OWNERC'I����i2E ADDRE53 CITY2IP PHONE <br /> •`7�c'�,C�c.;� LQ�C� c�Ci>N��.Jc�i7z-'n� i7LG%7��3c=t) lCrrlKLQr.'D i�.�/�_ `�S=C,.�S �7i�(��•r��7-_�G�7�, <br /> TENANT NAME ' I CONTAC7 F R PERMIT PHONE <br /> C�c—a t����r��- J�Y�,� �1�0�� ��.6U- [�-z�8 7s <br /> CONTRACTOR r� � � � '- A�DRESS CITY2IP PHONE <br /> «-�"�`�^^- ��`�' �.2 f'Z�� 1�7r�+4�c= 5G °�II �J�t- ��v<c r <br /> 7 ix`rF?C-tc <br /> CONTR.LICENSE A <br /> �? 't� D ��_/3L_ S G �1C� J Cu -t�L�-Cu�'�� "'<<�• �•5;'�G� <br /> USE OF BUILDING HEAT SOURCE I CON i RACT PRICE OF WORK <br /> (1C-�, i(X�Jc c- _Eleclric _Gas_ Other I`��c,�c.l' ' • �-�= <br /> WORK DESCRIPTION '- <br /> c�iw�z � ��uu l��.V� t,�,-�', 1��-,� �� 1� . ���-���w��� <br /> r �;_ �//�II , <br /> /1 \'� .o_z?��, � l/ ��V1J��� %Y Ll_ C�,. .. CiC �.i <br /> �/ <br /> PLUMBING MECHANICAL <br /> � "✓ <br /> N0, TYPE OF FIXTURE OR ITEM N0. NPE OF FIXTURE OR ITEM ' -� <br /> Toilet A/C—air handling units , , � <br /> Bathtub Forced air systems .�',, <br /> _ Lavatory(wash basin) _ Gas piping �J <br /> Shower Wa!erheater - � (,' ,� <br /> _ Kilchen sink&disposal _ Gas freplace .�. ��a -\ ; t�� <br /> _ Dishwasher Gas range � Q��� ` <br /> _ Clothes washer Clothes dryer ��� �7 \ � <br /> _ Laundry tray _ Range hood ��; �`ll ; �\� <br /> Sink(service/bar/mopletc.) _ Exhaust fan � �. <br /> ' _ Backflow preventer _ Heat pump gl ('` ' <br /> Urinal Unil heater L � �� <br /> _ Orinking Fountain Boiler r ��� `\` <br /> _ Floordrein RefrigeraUon ��'�`� <br /> Grease trap Woodstove �,-' <br /> � _ Roof drains _ Olher�_ <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hareby coritify lhal I havo read anC oxamined this appliwtion and know the samo lo bo true and corroct. All provisions ol laws end <br /> ordineces goveming Ihis type of work will ba complied wilh whether specifietl herein or not.The granting of a pertnit does nat presume <br /> to give aulhority to violateor cancel the provision of any other slale or local law regulating conslruction or the per(ormance ol <br /> consfruction.That I am autho �zed by the owner of Ihis property to per`erm Iho ork f r which application is made and I comply wilh ihe <br /> Stat nVadors Law{8.27 CW and 296.200 WAC. <br /> \ , Z p� <br /> Signatut o� wned ntractodAy horize gent ate <br /> 1 , <br /> ��- <br />