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------- - -� <br /> P�. :MIT APPLICATIO�. <br /> CITY OF EVERETT PERMIT SERVICES ,j � ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.M PERMIT p <br /> 3(.'� � � E 00•� 000a0 0 " � <br /> LEGA LOT N0. BLOCK TRACT OR 9UBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �n��,d� �� �c��� N� ��sf��, ��N��� 9Baoy `/�s"-�83-��!'/a <br /> TENANT NAME /� _ CONiACT/FORP E IT PHONE (,/'1S —3O �p��'t <br /> (Y l_/t'e !f'/ � I �LYA l-�L.7K-� E.MAIL �O4Ie�(`y� <br /> 1VaN Qc�i�,wl-#�`°cts��+x���ot�T-t�. /-/09- /3J�'�`S�S�V �eRe{! ��(�-S�C"0-,�3.5� <br /> CONTR. LICENS�M �Q aU cJ/C��1-I 1J ��/"u <br /> �� <br /> USE OF UUILDING HEAT SOURCE I CONTRACT PRICE UF WORK <br /> � �I � ���, ��^ <br /> S�,b�� � S s�l1A��l�`—s _Electric �Gas_Olher I .��c.�� <br /> WORK�IQN 1� <br /> Tfb�N� �iMPRO��ar-HZT <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYFE Of FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> BalMcb Forced air systems <br /> �'� Leva!ory(wash basin) _ Gas piping <br /> _ Sh,wer b� Water healer <br /> _ Kitchen sink 8 disposel �0 �� Gas fireplace <br /> Dishwashcr �� _ Gas range <br /> Clolhes washei Q � � �yW 5 Clothes dryer <br /> � Water healer �( /` rY(r _ Renge hood <br /> _ Sink(service/b.u/mo etc.) 1...� _ Ezhaust fan <br /> �ackllow prev�mte � Heat pump <br /> Urinal Unil hea�er <br /> Drinking fount n _ �oiler <br /> Floor drain Refrigeralion <br /> Grease tra Woodstove <br /> Roof drei Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE 19 J706 <br /> � I hereby certify ihat I have read and axamined Ihis applica�ion end know Ihe samo�o be true and correcl. All provisions of laws and <br /> ordinances goveming ihis type of work will be complied with whether specified herein or noL The gran�ing o(a permit does nol presume <br /> lo give aulhorily to vidate or cancel the provision ol any other state or local law regulatinp wnstruction or the peAormance of <br /> Iconslrudion. That I am a thorized by Ihe owner of Ihis property to pertorm the work for which applicalion ie made and I comply with lhe <br /> St,�le ractors .aw 27 RCW and 29Q200 WAC. � <br /> � , ���-8��ID � <br /> r�g�r � re o wn �d o actodAuthorized Agen� Dale /Z <br />