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1 <br /> ' PERMIZ APPLICATION j <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-af357 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM QO(R G� Ul J <br /> SIiE ADDRESS PARCEL TAX I.D.p PERMIT M <br /> �' � , ��,� -c. '7 <br /> LEGAL lOTNO. LOCK TRACT �, <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> C���l—�iflcc,k-«� C'���«- :,217/ ��� 1'c. �cll��.r- L' .�c�Ll- . Wla <br /> TENANTNAME CONTACTFORVERMR PHONE <br /> ��/ <br /> � 1" L'/�!Y ����ef,.� -� �? -/G <br /> CONTRACTOR ADDRESS �'Jb,Zy 15��/It S� ���Z�P PHONE <br /> /�;� .ir Mecl�ua�«�I aNc.. N2s• �"cd nsvo <br /> ;,.,,4c �v7.• B M•11.Crcc �C <br /> CONTR.LICENSE N <br /> M�Ilrr��c�cc,�;�, �'// %'''i�' Lv�i 4S�,i2 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> — — — I ��i �� cc <br /> Electnc �as Olher � <br /> WORK DESCRIPTION <br /> '���.1��rJc� '�r�ta � - �nt r ,—ie:w� <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FU(TURE OR ITEM NO. TYI'E OF FUCTURE OR ITEM <br /> Td�al NC-air handling unils <br /> Dalhlub Forced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower Waler healef <br /> Kilchen sink 8 diaposal _ Gas(replace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> � Sink(servicelbadmop/etc.) _ Ezhausl fan <br /> .� Backflow prevenler _ Heat pump <br /> Unnal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refigeration <br /> Grease Irap _ Woodsta�e <br /> Roof dreins Other <br /> Other <br /> CRY OF EVERETT LOCAI SALES TA%CODE IS 3105 <br /> 1 hereby cenlify lhat I have read and e�mined Ihis applicalion and know the same to be true and correct. All{xovisions of laws and <br /> oMinaces govemit.�thiz lype ot work will be complied with whelher specified herein or noL The granling of a pertnit does nol presume <br /> to give authon1y hda or cancel lhe provisim of any olher state or local law regulaling constniction or ihe peAortnance of <br /> construclion:Thal I am uthanzed by lhe9wner of ihis property to pertortn lhe work tor which application is made and I comply with the <br /> Stale�Conlradors Law 8. 396.200 WAC. <br /> %� l, �1:Z�-vG <br /> SignpWre ot er aet dAu nzed Agent Date <br /> l � <br />