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��C C�' 3° <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-895r -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM DG�Z dG �UGsi <br /> SITE ADDRESS ,� PARCEL TA�(I.D.# PERMIT# <br /> 2� c-'2- 6�'0 /�ll WA ' v� �'� �1502 "Co _ _ l "l�0��'1==-41� <br /> LEGA LOTNO. BLOCK TRACT <br /> oeso. � � - .3 L ' 7s <br /> OWNER ADDRE55 CITY2IP PHONE <br /> -7ii/clr)GL5 Cll/�NC7 /�/7 �`"f� /�✓e- � s�>s-��!/c 7�c��- �S� ��BU <br /> TENANTNAME CONTACTFOR PERMIT FHONE <br /> ��tv� d Mo � � I ,�y� w -�, tJ��C ��. �Pss', U-'-s -3v8 -� '7 �3 <br /> CONTRACTORZ/�(�/�� J\�(O�1pMFhj"nQ� �AyDDRESS < �f�� yrCITY2IP �f PH/O�NE(J���y ,(�] <br /> �U�l� �Ji�I�I `CC�r ��G' :J��O � J\. N\v f'.�1�.�J !��✓ lJ'�./✓�K�J� <br /> CONTR.LICENSEIi ����Q.jS�(j4P� Aq�UO � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WURK <br /> g�t Eleclric Gas Other <br /> WORK DESCRIPTION <br /> C,�MO\\�10Y\ 0�' Q� �U�S'�. "; S1�U� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR IiEM <br /> Toilel A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cblhes dryer <br /> Water heater Range hood <br /> Sink(service(barhnop/etc.) Exhaust fan <br /> [lackflow pre��enlor Heal pump <br /> l4inal Unil hoater <br /> Drinking Founlain Boilar <br /> Floor droin Retrigeralion <br /> Greaso trap Woodstove <br /> Roof drains Olher <br /> Ot�er <br />; — — <br /> CI1Y OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> I hereby cerili(y lhal I havo read and examined lhis applicalion and know lhe samo to bo Irue and correct. All provisions of laws and <br /> orJinacos govoming this typo of work will bo complied with wholher speci(ied herein or noL The granling o(a permit does not presume <br /> lo give authorily to violate or cancel lho provision o(any other slale or local law regulating construclion or the performance of <br /> conslruction.Thal I am authorized by lho owner of lhis property lo periorm the work{or which applicalion is made and I comply wilh the <br /> Stale C nlraclors Law 1�.27 RCW and 296.200 WAC. <br /> �� Cn � _�- �b�- <br /> Sig a re o(Owner tractorlAulhorized Agent ' Date <br />