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; . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STFEET, EVERETf, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ; <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# ', <br /> ! �l c�l �-q I� �} . ���-}� A- I 0 I l 3f,7=�j D�t;c� �o � - /C� <br /> LEGAL LOTNO. BLOCK �RACT <br /> oesa Q7 �1, IG # II Q I�-CD <br /> OWNER ADDRESS CITYIZIP PHONE y�����7 �� � <br /> �T L�1,��400ii'l�4^I- �tt�. Uv'ulcz �i012 LL'IIGt,� �lrG .S��K. i�� �Vei=�f-}- `��1;;) <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l�! �t'1�ti� tJ��v VN�1t�1 r� � �11'V�N- `� ��- �i�1��C�1rtj-h�'K ?��:3�� 73.c��:.. : <br /> �ONTRACTOR 1/ :;T1�`, r `� ,� ADDRESS CITYfZIP PHONE/_�� �.�!r, (�. C� <br /> L.l ..� l. 'L.i �l�y q 1 y��� , ,�y /j �^� 1 <br /> CONTR.LICENSE k �Z�TI�L��JI TJ✓ IC�J� ���`�7� fV'"{y� �U�ti'1.1 IiVG�L�I l �l��1.� <br /> �Xi�. O�.u�i. U`1 c��''it�/ �(77 <br /> USE OF BUILDING (_,'��,'/� �_ HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� � � (,�n L(; �Electric _Gas_Other $3Z9 �Z��. � <br /> WORK DESCRIPTION T"�'i'�Vi� I W1�����'t'�'�'� � C��'7't U I U I✓11 C. j'O I�"1(,-�lir� <br /> b'lCw �✓�t�n• t�t� (�.'tr-ti-it�a��s, ��l�vrN�v��j , C�I.�C'�1'b ��al, lioll•,-h►�9, <br /> Cvt�i�u-t�� av�ct i ��-+�h-�Lv �, v��s�les� . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet . ����� '� _ A/C-airhandlingunits -�l <br /> BathWb �j��( Forcedairsystems Iv �'�-'' <br /> _ Lavatory(wash basin) �f��"�V� _ Gas piping y�;���{ <br /> Shower ,���f� Water heater <br /> � <br /> _ Kitchen sink 6 disposal �� /1 1 _ Gas fireplace u�,r��ti� <br /> _ Dishwasher ���� `�lY� Gasrange /� <br /> _ Clotheswasher � Clothesdryer G�t��`���('(C <br /> _ Laundry tray _ Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaustfan �.���1�'f", <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3705 <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 rype of work will be complied with whether specified herein or nnL The granting of a permit does not presume <br /> to give authonty 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 lhe <br /> State Co a t rs Law 18.z7 RCW an a96.200 WAC. nq <br /> �I��✓.����L���/L.L�,�ti� L�. 0 ! � <br /> SignaWre of O ner/Contractor/Authonzed Agent Date �/ <br /> Z <br />