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t <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.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD-DRE� PARCEL TA7C I.D.M PERMIT 11 <br /> �n w sTI�T j o �'/G �l�3. .9x�'S-� <br /> LEGAL LOTNO� BLOCK THACT �'/,C��J�.��— <br /> DESC. <br /> OWNER AODRE33 CITYILP PHONE <br /> G��'rT'Ga�kru�.rrf' zG�7�,tr�e5� ,�/�/�390 �.d�.t51; <br /> �� � <br /> TENANTNAME � CONTACTFO ERMIT �f PHONE <br /> lu� /�/fi� /�/�N�� zs� a <br /> �av� fraascr�. af 7700 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE t <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE O�IVORK <br /> ��Gr �L��tMxAs _Eleclric _Ga�_Other "'/��=�j�-C�(J <br /> ' � •_' <br /> WORK DESCRIPTION �0� �L �4,�.� (�w��L�p�/� <br /> i, �IoG�t� EJo'tTr"'¢' � �.�D/��N•fil�Slr � / - ' <br /> Gek< �brwo.�I ,ft. D <br /> z. G,.��,�,�� ,��,��,���T of ��-,� �.,,�.,�S�N��,�� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handlina units <br /> Ba1Mu6 Forced air systems ' <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> K;tchen sink 8 disposal Gas fireplace <br /> Oishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> 8ack0ow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EVERETT LOCAL SALES TA7f COUE IS 3106 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and I <br /> ordinaces goveming ihis lype ot work will be complied wilh whether spedfied herein or not.The granting of a pertnit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulatinq construdion or the perfortnance of <br /> constmdion.That I m authorized hy the owner of this property to oeAortn the work for which application is made and I comply with the <br /> Slate-Contrattor L 18� and 296200 WAC. <br /> � �� ,� _ / <br /> �i � � � /�G��l����j� - (�4�/71. <br /> Signature of OwneU onlractor/Authonzed Agent Da1e <br /> �/� � <br /> - ----�-- � - ---- --- <br />