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PE�MIT AI�PLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8910- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT M <br /> ZSoS C�1 �lE+Q �4v� �-{3-7 �7 �003 ono3 <br /> LEGA LOTNO, BIOCK TRACT <br /> DESC. "3 " �l 5-71 ��vr.�-r�*r D�� � <br /> OWNER AODRESS CITY2IP PHONE y2 S <br /> �Yo/'�5�'�l� 18z� fZurN1'+� fl+� F�vtR� ,,�q 95ao� zSz o?5 <br /> TENANT NAME CONTACT FOR PERMIT PFiONE <br /> "�f1'(Lo(Z Jor-r� an�sv��G9 �-!2S '�'�t- - lYBZ <br /> CONTRACTOR �� �,v, A ���tn�+ qppRESS P°• �°Y CITY2IP F� PHONe yr5_ Z 3 z. <br /> � z;zt. � �rSZ <br /> CONTR.LICENSE M �(ZO D E D C 9L Z O G <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK. <br /> ��roG� F�..,�c y -- — I <br /> ElecMc k Ges Other Z.Soo <br /> WORK DESCRIPTION <br /> �{TY7 tvit,Cr i Fy4rrr74l� � 9 LAr%97�S�y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUfTURE OR ITEM <br /> k Tollet A1C—air handling uNts <br /> � Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas flreplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mopletc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain Boller <br /> Floor drain Refrigerallon <br /> Grease trap Woodstove <br /> I _ Roof drains _ Other_ <br /> , Other <br /> I — — <br /> I CITY OF EVERETT LOCAI 9ALE3 TAX CODE IS]105 <br /> II hereby ceritity that I have read and examine�this appllcaUon and know the same to be true and correct. All provlsions of laws and <br /> I ordinaces governing this type of work will be r.omplied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the prov�sion ol any other state or local law regulating construcUon or the performance af <br /> consWction.That I am authorized by the owner of this property to peAorm the work for which applicaUon is made and I comply with tha <br /> Stal on� to Law CW and 296.200 WAC. <br /> I <br /> � — 1�-B. by <br /> 'I Signature wned(, actoOAulh nzed gent ate � <br />