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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVtCES <br /> 3200 CEDAR STREET, EVERETT, '/'/A 98201 <br /> 425-257-8810 - FAX 425-257-8857 -ww��v everettwa org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM MU�,• (��(p <br /> � SITE ADDRESS PARCEL TAX I.D.M PERMIT M � <br /> 4GI� �4sscuat�0 bw 6u <br /> 1.EGAL LOTNO. BLOCN TRACT <br /> oes: �„ � 2df66� � �6Zsi��'i <br /> OWNEft A�DRE35 CITY!ZIP PHONE <br /> Mcv,utAr� wEN c..c.c 164rz� scun+c�Q R�akr.,rr S�n�/ 9er8e �•�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> MawMTAw �IEu l.cc. � �y �3-9S�-Sso/ , <br /> CONTRACTOR / }� � r,A7DDR,E+�SS / �/ CITV!ZIP �,/ PHONE � <br /> � �KlVEII`�/ /����CJ�3yy�✓%1 / C [��'� �lY flu��WN� lNi'T. `7UL�// <br /> CONTR.LICENSE M � /7��� (�3��SC'j� <br /> ( <br /> USE OF BUILDING HEAT SOURCE � C(SNTRACT PRICE OF WORK <br /> __E�ectrc 1( Gas_0`^_ ��s' ��' <br /> r <br /> WORK OESCRIPTION f/�j,�{-C rti e c<Lr�rra�•�- IAfaTqL.L (2) ERHq� FA� � <br /> ��� UMIT lf6iF16iCS <br /> PLUMBING MECHANICAL <br /> NO. TVP=OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ToJet _ A C -a.r ha^tll�ng cnrts <br /> Bathtuo Forced a�r s�s!ems <br /> Lavatory(wasn tas��.� I Gas p�F�rg ' <br /> ShOY.'I _. WdtEf h8dt8f � `J" <br /> K,tchan s�nk 8 d,soosal _ Gas frap�ace <br /> Disrnvashe� _ Gas rarge / <br /> Ciothes roasnar _ C,othes dryer ^\v / <br /> Laundry tra� Range hcod � � v I <br /> S�rk;Servica�bar mx e!� � 1 Exhaus'fan / � <br /> BackFlaw pre�.en�ar Heat pump �\ <br /> Ur�nal � Umt hgate� �` <br /> _ Ornk��rg Fc�.,rtar' _ Bodar <br /> F',00�dram _ Rafcgaretion <br /> Grease traF _ Wocdsrove <br /> Roof Ara�,ns _ Other <br /> Other — — <br /> CITY OF EVERETT LOCAL SALE9 TAX CODE IS]105 <br /> I �ereby cert'y that I h?�ie�eaa ard e■am�ned this appuca'��on and Know the same;c ba tr..e arG �orrect All pr�vis��.a�s �f��aws antl <br /> ��r9ma:es go�e'^��"q c`'�.' c/�e =f r��'' ^'i�Ce compiietl wdh �nhether specfetl nere�e or noc T:^e grantrg of a oermrt:foes not pr=sume <br /> to ���e a�thor��r, �.v���a�?�� �a^�e'� ;ne orrrs�on o�any �ther state o�iocal 'aw reguiating co�structon or the perto�narce of <br /> ;,;�s�r.ch.cr T-a�-�"^3�..�"o��zed oy �re ��.vrar ot tr�s or�per,y tu pe�o�m the•.vork �cr�n,�,�r apDi•:ca!io^ �s made and I comply with the <br /> i�; ` <br /> S'ate�.art s La�.v d�' RCW nd 299 blA:. <br /> � %��, �.1��` 2 �i/oe <br /> �S.g� / �.y �. .,;�ri;:b�A�!hcr�z'] ?9`^c � a'�— �I?i <br />