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(---- - <br /> I F`RMIT APPLI�ATIuN <br /> I CITY OF EVERETT PERMIT SERVICES �U �Z/ <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org /�'��Z _��I <br /> � � G� <br /> i APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> i SITE ADDRESS PARCEL TA7(I.D.# PERMIT p <br /> 2// 6fl�an� u�N� oos�s�- ouo -nos-�o� -vP i3�asu <br /> � LEGA LOiNO. BLOCK RACi <br /> � DESC. <br /> OWNER S P#- 1 ao a-oa►- oa, <br /> ` ADDRESS CITY2IP PHONE .� "� <br /> �,,wv�1�' (3�. �.v�,ST. 3�a'� �����tic �nr.� �� 9�•zo, _. <br /> i 7ENANTNAM: — CONiACiFORPERMIT PHONE <br /> I ;�ei ��k `-�Zs- Zqo-�,.y 2_�f <br /> . eONiRACTOH ��-�Q=��ZDZ A�ORESS <br /> I 39ZZ, fSl ��(, f�lE CITY2IP PHONE• <br /> � CONTR.UCENSE%Nf�Ack (3(2cY,. Cc� NST. ��TM C��s `I7S�3G1-�36U <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S1 � Electric�Gas Oiher '�V���� <br /> � WORK DESCRIP710N <br /> I ►J �-`� S F,� <br /> ; �.(DlG �Z9 <br /> � <br /> I PLUMBING MECHANICAL <br /> �, N�• TYPE OF FIXTURE OR ITEM h L TYPE OF FIXTURE OR ITEM <br /> I � Balhtub aC—air handling units <br /> Forced air s stems <br /> Lavatory(wash basin) � Gas i in Y <br /> � L Shower p P 9 <br /> Kitchen sink& disposal �. Wa:nr heater <br /> Dishwasher � Gas fireplace <br /> � Clothes washer �_ Gas range <br /> Laundry tray f_ Clothes dryer <br /> I _ Sink (servicn�badmopletc.) 1 Ranne hood <br /> Backllow pieventer � Exhaust fan <br /> i Unnal _ Heat pwnp <br /> Drinking Fcuntain _ Unit heater <br /> Floor drain _ Boiler <br /> Grease trap _ Refnce�ation <br /> Roof dreins _ Woodstove <br /> Other _ Other <br /> _. _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined(his applicatlon a;"_know the same to be true and correct. All provisions of laws and <br /> ortlinaces goveming this type o/work will be complied with whether soeci�ed herein or not. The granting of a permit dnes not presume <br /> to give authonty to violate or cancel the provision ot any other state or local I�w regulatin; �;onstruction or the pertonnance of <br /> constructir,n. T t I am authonzed b the owner of this property to perform the work tor which application is made and I comply with the I <br /> te act s aw i8.2 RCW� d 29E,200 WAC. <br /> S nature Owner;Contractor, hou dAgent �`'�pa� I <br /> � <br /> .i I <br /> S� �Z `'�/ � <br />