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� � z-�-3 --a.5 <br /> � � PERMIT APPLlCATION 1 <br /> CITY OF EVERETT PERMI'� SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX A25-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> gi*F ennnESS PARCEL TAX I.D. # PERMIT# <br /> ,o193s Cc�h �����t C' �' : - (� So5�2-C�o <br /> I <br /> LEGAL LOT NO. BLOCX TRACT I <br /> DESC. �,�_ 7 �> � � �� <br /> OWNER ADURESS CITY2IP PHONE <br /> F��� �r � ���., ( { �� � a,qbS �avhvoek N 1U Ta.1\2.6�dSSE4, , t=L 333�g <br /> TENANT NAME I CONTACT FOR PER li PHONE I <br /> ���1'.1L`:� TtiliCcvv� �dv� ��,�.-�cv� ��11S���IQ' �C'14 <br /> CONTRACiOR AODRE55 CITY2IP PHONE <br /> (�,�c11u i\;Ccr.,�v�c, �1�i.0 i{d.bo,.- ��ac� (��v1�Cl\��:c: i��a5) 3`t�( -sc�yy <br /> CONTR.LICENSEp jL� �� 14�7� <br /> f� (1�:... Ni r,v�1 c.y� { �-G E l � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> LL`i'`�NntYC��1 I __Eledric _Gas_Olher I � '3��aU`�' <br /> WORK DESCRIPTION <br /> 1v�`�'�a\1 CI) '�1\v�M.v.xZtcl =.�cJ.. l`Zb��✓�°�'j' � <br /> PLUMBING MECHANICAI <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OI'FIXTURE OR ITEM <br /> Toilcl A/C–air hondlinp umis <br /> E3athtub Forced air syslems <br /> Lavatory(wash basml .__ Gas piping <br /> Showcr _ Water healer <br /> Kdchen sink 8 disposal Gas lireplace <br /> I Dishwasher _ Gas rangc <br /> � _ Clolhes washer __ Clolhes dryer I <br /> __ Laundry tray __ Range hood I <br /> Sink(servicefbadmop�etc.) __ Ezhaustlan <br /> Backflow prevenlci __ Heal pump <br /> Urinal Unit heater <br /> Orinking Foimtain Boiler <br /> Floordrain __ Refrigeration I <br /> Grease Irap Woodslove <br /> Rnof drains Other <br /> Othcr <br /> CITV OF EVERETT LOCAL SALES TAX CODE 151105 <br /> I hereby ceritily Ihol I have read and examined this apphcaUon and knuw the same lo be lrue and correct. All provlsions of laws and <br /> ordinaces governing this type of work will be complir.d wnh whuther specilied herein or nol.The granting of a permd does nol presume <br /> lo give authority to violale or cancel Ihe provision of any olher stale or local law regulatin9 consiruction or the peAormance of <br /> construclion.Thet 1 am aulhorized by the owner of this property W peiform the work tor�vhich appiicalion is made and I comply wilh Ihe <br /> Slalo Con�rac�ors Law 18.27 RCW and 29G.200 WAC. <br /> ��,.N. �0 1 a-2-2�-o J <br /> Sig�ir ature ot Owned n rectorlAulhoozed Agent Date— � <br /> �' <br />