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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.everettwa.org <br /> i:t%() APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / 1 7 -Ob <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT# / I (J5` <br /> •;cir-C, ifv, E. iz.r •1J:.. 11 f nL (ilii( <br /> LEGA- LOT NO. BLOCK TRACT <br /> DESC <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> .3..0.Ut40r ._,ri Cz��jl-'T'f I9O1, f .•t .L=r c.Lt_Liz- E-ye-ten-7- e1 Q, L.[. <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 7!J.Jf-)titIr.-1, •_-r-? (4O>A.)&• t r-\J 1 ti Erb'1'e,. ('1z::)• F'''S '1a c>C; <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> L\J . 1) , .7.D...- 7-1 , (1) .•"1%"AJ/ .-1-7.•6' 77.)'''1 170t, A-Vc.vlti,v,lttr c1L,,cJ . 1 7 <br /> 7-- <br /> CONTR.LICENSE# <br /> L'•)Pt t...7 c_ 'r Ur,'iAA _ (Azs),A9., 15()4' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> CF W;.IC..--•v`1z oar __ Electric _Gas_Other (/ Z 'iL.' <br /> WORK DESCRIPTION _ j� <br /> 9,,J,M C�� i , ' Td';. L t " T Fc C �..1��(TGL 11-12e)OA <br /> Ty}.-1- <br /> -rnI OOr A ,, i I C - r ,�/,/ <br /> PLUMBING , MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM /6,,;,,), <br /> __ Toilet A/C-air handling units <br /> __ Bathtub Foy ced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> — <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer I Heat pump <br /> _ Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> — Floor drain Refrigeration <br /> Grease trap Woodstove <br /> — <br /> — Roof drains Other <br /> I Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> - I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont : • - aw 18.27 RC an 296 1 1 t • -. <br /> Signature of Ow •r/Contracts r/A honzed •gent Date <br /> / <br /> i <br /> / <br />