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f� - 5 -� � <br /> P�KMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICAT10N3 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.N PERMIT It / <br /> .Z �1/ �S�ho T�d Lvo�-e� ��/' �jC: - -lU/Li <br /> LEGAL LOTNO. BLOCK TRACT eQ /� � � <br /> DESC. �'I � Cw.�sa/c.0 /'1 a7" N+rr+, S <br /> OWNE AD R S IC/ITY21P PHO E <br /> Zha.�le �rQ, i��z2 13�7j�GvovNE, T�o1���rv�J �4aS�.�a`i- o-d <br /> TENANT NAME CONTACT FOR PER IT / PHONE <br /> I � ..� .�S,o�-s....�E/! q�2� 7rv - 722� <br /> CONTR/1CTOR ADDR � CIhILIP PHONE <br /> � -� �a�;1^y L L G �!�24 f! Dr.s�; 1�o�.�,/T�v�1 3so21 C��51z8 6'6°S� <br /> CONT .LICENS M lJ <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,/`���,�,.J'4� [lectric Gas Other ~^-��0� � <br /> WORK UESCRIPTION n /J <br /> c J�' �r: n, 3�wX �"m"p. Ivo � <br /> / fv <br /> fZe-�ol1wti : � �o�Pr o�ca,�„�oR, f�z... _>`,.� � wer � i <br /> 0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet NC-air hendlfng units <br /> Hathtub Forced air sysfems <br /> levatory(wash basin) _ Gas piping <br /> Shower _ Weler heater <br /> Kilchen sink 8 disposal _ Ges fireplace <br /> Dishwasher Gas.enge <br /> Clothes washer Cbthes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicePoar/mopletc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Flaor drein Rehiperation <br /> Greesetrep _ Waodstove <br /> Rool drains Other <br /> Olher __ — -- <br /> CITY OF EVERETT LOCAL SALE8 TAX CODE IS]105 <br /> I hereby ceritify that I heve reed and exnmyted this epplicatbn end know;he same to be We and cortect. All provisions of laws and <br /> ordinaces goveming Ihis ty�oi work will 6e Qomplied with whether spec�ed herein or not. The granting ot a permit does not preaw ve <br /> to give authonty to violate or cencel the�rov�bn o(any other slale w loca!law reguleting conetruclbn or the perlortnance ol <br /> construdion. Thal I am aulhaized by Ule9'�'ner ol this property to peAorm the vrork for which applicalion is made and I comply with Ihc <br /> Stale Contractors Law 18.27 RCW anfl ZA6.200 WAC. <br /> � , <br /> �-� _ >�-.� v�i � "� 5��9 � � <br /> Ignature ol wner/ on racTorlAuthar¢ genl a <br />