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r <br /> I � .- <br /> P��1MIT APPLICATIO�J <br /> CITY OF Eb'ERE i T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 —www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TRJC I.D.# PERMIT# <br /> �S.3C� t,' VLI' ee,✓ Do39 Z DO 3 6I OOG �� �/ <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 13ocs�� �,,.}��a,- ; s.•5 v�z � ��fs- �� f'c s� s.�o. � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> 6 ri �,� Mo-�orS co[� iSie,.� S•fcve. I�Lou, �, v�s- �6-S�ss� <br /> CONTRACTOR �� ��/ N[v.v c a ADDRESS ` CITY2IP PHONE <br /> 75�ov //M•-Pao�, i..� Y2S- 776-88 3,$— <br /> CONTR.LICENSE# �z���rNco77cr+. ��av�,FF C„F 5ffzo3 <br /> ,_� <br /> USE OF BUILDING I — HF_AT SOURCE I CONTF2ACT PRICE OF WORK <br /> Gh-r raat-�'� <br /> Electric Gas Other �� ��� /Sp, O a <br /> WORK�ESCRIPTION <br /> i�.s1a« ci� po�� S;yN � o� c�q-�c s;�,,, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Ciothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> � _ Other — <br /> I — — <br /> I <br /> CITY OF EVERETT LOCAL SALES SAX COOE IS 3105 <br /> I hereby ceritify that I have read and examined thia applicatlon and I:now the;ame to be true arid correct. All provisions of laws and <br /> ordinaces goveming this type of work will 6e 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 consWction or the performance of <br /> construction.That I am au orized by mer of is property to perform the work for which application is made and I comply with the <br /> IState Contractors Law 27 R 29 AC. <br /> � � �3�,�, <br /> ,' Signat of 0 eUConlract /Authorize�Agent �' Date �/� <br />