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3 -� --� G <br /> PERMIT APPLICATIOId <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everPttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.q ERMIT p <br /> � < <�_ .� � �;�1. ��U��l ���� ��03- 632 <br /> LEGA LOT NO. BLOCK TRACT � � <br /> / [� <br /> DESC. S I � - ��.�/�'f� S. <br /> OWNER ._ AD[1RESS CITY2IP PHONE <br /> ��•�+`J t' C�r <br /> TENANT NAME CONTACT FOR PERMIT ! PHONE <br /> I ��� <'��,,.� 1, �9�-s� 7�r- ?.��i <br /> CONTRACTOR .� ADDR � CITV^21 PHONE <br /> r=�� < : s/ �e.��..5 ,LL �� 2/91�} /-�-1� �r� ��J/���, (•47 980�1 �'�25�770 ..;��]�- <br /> CONTR.LICENSE N <br /> USE OF BUiLDING . I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �1 -� � Electdc Gas Olher �� 9 � � <br /> l.oh-,rl-e�J ,`..� — -- — 1 <br /> WORK DESCRIPTION � � n � <br /> r � /,� � 3- ta.(f ce.._r r <br /> PL.a .j�n '-�L� Z.' /<>,�r- uJ Gdi.� SIi��C�^c�S .irLf J�1<i�..� <br /> ) / <br /> i � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilol A/C-air handling unils <br /> Balhtub Forced alr systems <br /> Lavalory(wash basin) _ Gas piping <br /> Showcr Watar healer <br /> Kitchon sink 8 dis{�osal Gas tireplace <br /> Dishwasher Gasrange <br /> Clothes w�shor Clothas dryer <br /> Watarheator Range hood <br /> Sink(sorvicc/barlmopletr..) Exhausl fan <br /> ^ 9ackllow prevenlor Haat pump <br /> Urinal Unil healor <br /> Drinkin�Foun�ain _ Boiler <br /> Floor drain Relrigeration <br /> Greasolrap WooAslove <br /> Roof drains _ Othar <br /> Olher <br /> CITY OF EVEREiT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilily�hat I hava reaA and ex2mlryed lhis applic:ation anA know ihe same to be iruo and correcl. All provisions of laws and <br /> ordinaces yoverning Ihis type of work w41 b�complioA with whelhor specified herein or nol.Thr granling of a permil does nol presume <br /> to give aulhorily lo violate or cancel lHe provision ot any other sta�e or local law rogulaling construction or lhe performance ot <br /> construclion. That I am authorized ify the ownor ol this property to perlorm the work for which application is made and I wmply wlth the <br /> Slale Contraclors Law 18.27 RCV�and 396.200 WAC. <br /> �_���-� � -3�3�o G <br /> Signalure of Owner/Contractor/Aulhorizod Ayent Da� <br />