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PERM�T APPLICATIQN � <br /> � VICES <br /> I CITY OF EVERETT PERMIT SER I � <br /> 3200 CEDAF STRE�r, EVERETT, WA 98201 <br /> �25-257-8810-FAX 425-257-8857-www.ever�ttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ����rv <br /> SITE ADDRESS ��-��'y� PARCEL TAX I.D.p PERMIT � <br /> l3aad,� N�<. L�hdt- �,a 9g�o� I S 3 � �� I � � <br /> LEGA LOTNO. BLOCK TRACTORSUB�IVISIONp <br /> DESC. <br /> OWNER ADDRESS / CITY2IP PHONE �I <br /> T C KI�ryJ'1 ��/� T�/ �t1 ��� S� L�1.���� �a�l': 77�� 5�, )-� <br /> � i l l w'N'F� <br /> '�TENA T NAME CON ACT FOR PERMIT PHONE(NZS �?!- 3f30 <br /> �J�n0.Uc-'h) - L�o �A S e o (���'�t�� e•r.�a�5�V'S.JSAeG/NA1L•Cbwt <br /> N RA 0 / <br /> �TQD(-y,��rC Su'✓i S� S" 5 4i��r��. r �� S�c•r,t#I� .�,Jr7 5':�'�3 `I I <br /> COIJTR.LICENS[7t � r � �yA �G>- , <br /> �,�L-"i�,- _�f� )S"ini ,�:� ,. � 7 <br /> USE OF BUILDING HEATSOURCE CONIRACT PRICE OF WORK <br /> , i�7,✓, <br /> 0 ej0. 1 _Electric �Gas_ Other t � <br /> tl <br /> WORKDESCRIPTION 'r. �. �Y .�'qS} �'Op� YtS�av.faHt ��Jit�+iv� PX�S+iH```��� b�+� iH . P�r'h��'�. c `�c I <br /> �a'.�ti•�y�� SLOJC e� l+�Of� lnL�l.�l5 ba+tiraow,s� k���CH � �iH1U.�, 4fG�� A�� CC���N�� � <br /> Ne eiv�t�•�,1, �ext���cr ��lt , or s��c wtod���c.i�to�.s . 4 I <br /> PLUM8ING MECHANICAL <br /> Np. TVPE OF fIICTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-airhandiingunils <br /> Ba1hWb _ Forced air sys�ems I <br /> Lavarory(wash basin) _ Gas piping li <br /> Shower _ Waterhe2!er .. <br /> Kitchen sink 8 d�sposal _ Gas lireplace , <br /> Dishwasher _ Gas rangc . <br /> Clothes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan ,I <br /> Backtlow prevenler _ Heal pump <br /> Urinai _ Unit healer <br /> _ Drinking Fountain _ Boiler , <br /> Flour drain Refrigera�ion <br /> Greaselrap _ Woodstove <br /> Roof dreins _ Uther <br /> Other — <br /> — —. <br /> CITV OF EVERETT LOCAL SALES TAIC COOE IS 9105 <br /> I hereby cerilily that I have read and ezamined this applicalion and know�he same�o be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whelher specilied herein or noL The granling ol a permil does nol presume <br /> to give aulhority to viol2`r,or cancel the provision ot any other state or local law regulaling construction or the perlormance ot <br /> construction.That I am�uthorized by Ihe owner of Ihis property to pedorm the work fo�which application is made and I comply with ihe <br /> Slale Contractors Law 18.27 RCW and 2962001^!AC. <br /> /�L S 7 <br /> � �,�- �-+� '� <br /> SignaNre ol Owner ontraclor/Aulhonzed Agent Dale <br /> 'lz <br />