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PERMIT APPLICATION j <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857-v+ww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRQM 8 AM TO 4 PM �/�I S � fJ� <br /> SITE ADDRESS PARCEL TA%I.D.# PE�RMIT# <br /> 3211 �iu0.�l.�a"1 Ao.' 2V �0�3�(�� � ZC3U SU� �l �/��U.} <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. S -41,ru �102.. Evcre,'�' (an� C O S �,s+ Nd,_ f3!-�c �6Z +�-6a <br /> OWNER ADDRESS M CI SZP1� PHONE n <br /> �1tie1C,�li✓� i�Ur,�'.. l`SOi� �1a'i�tit 1��. NE wn� a �aii N ��� <br /> T NANT NAME �� � r CONTACT FOR PERMIT PNONE <br /> �4�'DorG�d� n��lls� ��,��� ��yl c�rG N�c► L�oe> �1e4 - �los8 I <br /> sutvt-,��.c -- �vcrctt- � <br /> CONTRACTOR �ADDRESS CITY2IP /.�PHONE <br /> V1nc.c,po�nwl(y. M�1lJlf 11i� 1�tkr���- lLr� S� �d-�b) � (e�-4?7 �j <br /> CONTR.LICENSE M Se�+{�-��(,JA � �D�j <br /> mrac.c�o�s g�o 2u Iz- � �- o� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C�m�'� � �-�^\ — O�1 � I �Eledric _Gas_Other � � '�j v l7 <br /> WORK DESCRIPTION <br /> �s�atl rLtrt��su6,T1:� rh.u �t� zore, splr-�- s S+a�. �,.. i+1. oti-+dcro � <br /> wr���' o+� �o F be-h�;�8 po,rc.�� , `,£n5�"ll � i r��cror w��1-S wT� <br /> r'c-�w iQir� o.� �^b.cmS`ik'e ��-�-�v. <br /> PLUMBING MECHANICAL <br /> N0. � TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � <br /> _ Toilet� A/C–air handling units <br /> Bathtub �� _ Forced air systems <br /> _ Lavatory(wash`6asin) _ Gas piping <br /> Shower ��� _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <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 /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrop Woodstove <br /> Roof drains � Other M u��� or� <br /> Other_ � �, _ ' <br /> — \— ��.�'T <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�106 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and corred. All provisions of laws and <br /> ordinaces goveming this type of woik will be complied with whether specified herein or not.The grenting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construIXion or the pertormance of <br /> construction.That I am authorized by the owner of this property to periortn the work for which appliwtion is made and I comply wiih the <br /> State�ontrectprs\Law 1827 RCW an YQD WAC. <br /> \ J a�__I�-��-� 11-I S-- O� <br /> ign2lure of Owner/ ontrector/ uthonzed ent ate �� <br />