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P�r2MIT APPLIC�►TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAl(I.D.# PERMIT# <br /> G`I I � r ci c� # Znn QO(�GZ''G� <br /> LEGA LOTN . BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE ✓`I � �,� <br /> �e �-�� jrb�ei �tS `C�L � ��'`� 1�' �,� N�'' (ivc�o�'L^ c��p7� <br /> TENANTNAME CONfACTFORPERMIT PHONE <br /> �nv���s � + �� f l���,r m �o-t m-t V>n 1'3 �e r� c_m-, �yU� �fs�y-��'/S 3 <br /> CONTRACTOR • ADDRESS CIN21P PHONE u <br /> i.7Rcc. Cor���� lr���s E�� 1/al� /hN� k'� Y��z (yz�(oi� 5�sd: <br /> CONTR.LICENSE# <br /> Df{CD*o�2 n�L <br /> USE OF BUILDING HEAT SOURCE . CONTRACT PRICE OF WORK <br /> _Eledric _Gas__Other <br /> � C„ 3z� �� <br /> WORK DESCRIPTIQN I � t / p � ! 1 <br /> `������ ov,1d �.�J'!a-�/ /4-Ul..'t� y-f�c.l� S <br /> d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IT€� <br /> Toilet WC—air handling units <br /> Bathlub Forced air sysfems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> � Ki(chen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Ciothes washer Clothe�dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.j Exhaust fan <br /> � BackBow prev2nter Heal pump <br /> ltrinai _ Unit heater <br /> Drinking Fountain Boiler <br /> Ploor drain Re6igeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> C1TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions oi laws and <br /> ordinaces goveming this type of work wiVl be complied with whelher specified herein or not The granting oi a permit dces not presuma <br /> ro give authority to violate or cancel the provision of any other state or bcal law regulating construction or the perfortnance of <br /> construction.That I am au[horized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrectors Law 1827 RCW nd 296200 WAC. <br /> , � <br /> ' ' / z✓r 7 �L <br /> Signa ure�uf wne� acror/Authorized Agent . e <br />