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-- _ - i <br /> , . �� ;=��, ,. ;� _ i . ; <br /> PERMIT APPLICATION � � '-��. � � �� , � <br /> CITY OF EVERETT PERMIT SERVICES MAY 0 4 200c <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g -17� O (o <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org C I T'! O F E V i:;�c i ' <br /> �n:unc�:nnpiFni,Lc <:�uv��'�; . <br /> APPLJCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.S PERMR N = <br /> 5J�J c✓t,L 6 i��✓ i,=/;'�' O � 3 9 3 � �:U I � � l � � I S l?D'� ' �= <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. � N t�,/ILI: I <br /> OWNER � AUDREFS CRYi1i? PHONE f <br /> 5 j� V;r� � � �3,./ P.:. . a:x s � 3 o E✓Erv�-r, 9? �I 3 <br /> TENANTNAME CONTACiFORPERMIi PHONE ' <br /> PIL�C,J ) J� /J C o1, �J��S�N I -T]vN v75 ViM>r�LwcJD � :,� - S �f7,- �,. 73 � .. <br /> CONTRACTOR ADDRESS CITYZP PMONE .� -_ <br /> S1�vIZ£L.v�✓t SS ���•� � �}-�N.I-.� C <br /> CONTR.LICENSEN � �.:y�f- /}v� R-c �i.R /�t�f.. /.� , S Ij�o �L�E I�.LN� i �( �< I? � ..r <br /> S /l:, /L£ SA `IBI ��✓ <br /> USE OF BUILDING HEATSOURCE CONTRACTPRICE OF WORK � " <br /> - C� o/`7 h� FijL(��- L I _Electric _,Gas_Other I � �; � S uv . u .� -� <br /> WORK DESCRIPTION <br /> 1-rl-.? i�Lc;f�- /1�"� Y,.i s %7� L C_ 1 L � ��n .-,�.f+�'S—r �> S� r= � �o v�z_ <br /> � il-��- N 7�� (. w=-..i�-f V,..,.� �C� C IL/�-r-= H7=. �-S_ ,. <br /> ' PLUMBING MECHANICAL . •-: <br /> I NO. TYPE OF Fl7CTURE OR�TEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Toilel A/C-airhandlinpunits <br /> _ Bathtub Forced airsyst�ms <br /> _ Lavatory(wash basin) Gas � in � <br /> Shower — P P 9 <br /> Waler heater <br /> KAcfien sink 8 disposal . Gas fireplece <br /> I _ Dishwasher Gasran�e . <br /> _ Clolhes washer CloLhes tlryer <br /> _ Laundry lray _ Range hood " <br /> _ Sink(service/badmop/elc.) F�chaust fan � " <br /> _ Backtlow preveNer Heat pump �� <br /> Uriral UnR heater - "^ <br /> _ Drinking Fountain _ Boiler '�-.. <br /> _ Floordrain — ReGigeralion � <br /> Grease Irap Woodstove <br /> _ Roofdrains Olher <br /> � <br /> Other <br /> CITY OF EVERE7T LOCAL SALES 7A7(CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and knaw the same to be true antl w�n_a. pfl p�vi,ions of laws and <br /> ortlinaces goveming tbis type ot work will be complied wtlh whether specified herein or not.The qrg,tirr��a;�e�nk does not presume <br /> to give authority fo viofale or cancel the provision of any olher state or local law regulating ccns(nir,ti,n s�"he,a4ormance of <br /> construction.Thal I am aulhorized by the owner of ihCs property to peRorm the work for which application is n.:--«a 5i�I comply wfh the <br /> Stale Contradors Law 18.27 RCVJ and 2°F?�0 WAC. <br /> � � <br /> -� 'Z �.�Z—��-� a �r �� F -: <br /> Signature of OwnerlConlractorlAulhonzed Agent Dale � % I . � <br /> l � <br /> �� <br /> << <br />