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, <br /> � PERMIT APPLICATIUN � ,1r <br /> CITY OF EVERETT PERMIT SERVICES /�-��,3 ��`�'� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 !'�/� <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org � <br /> APPUCAi iONS ARE ACCEP'�ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A P RMIT# � <br /> 3� � ��� �9o.s�� �o� oo �oo��1 -���o.� <br /> IEGA lOTNO. BLO K TRACT I\ <br /> DESC. \ / <br /> OWNER �_ AUDRE55 CI1Y�l,lP --PHONE� -- -(+,Z��� <br /> CCt1S—�-��'tS� L�C '�f�zv��tC/' ���"c�'�; �+4- 1�'r-f�",�5 <br /> TENANTNAME �NTACTFO PERMIi �PHONE <br /> I /�'�c.� �4s ( c3J` �4�' �-c�"� <br /> CONTRACTOR �{ ADDRESS CITY2IP PHONE <br /> � <br /> CONTR.LICENSc# <br /> USE OF BUILDING HEAT S6URCE CONTRACT PRICE OF WORK <br /> _Electdc _Gas_Other ��"7/� <br /> WORK DESCRIPTION / /7 /� ` r � / c� <br /> 'r7nn �5/-� S'�iecb t- /Ce,G� ( /'G i 1-�- ` �(Ce�M�fee 1 cr^eJ I: c`L� �-I-�C L`✓` C.�CCu/h'^.'�' <br /> Ucl� %/ ,�4Ge � . / , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR I7EM <br /> Toilet A!C-air handlipg unils <br /> Balhtub Forced air systems <br /> Lavalory(wash�asin) Gas piping <br /> Shower W iler heater <br /> Kitchen sink&disposal Gas fireplaca <br /> D'IShW95h9f Gas range <br /> Clothes wast�er Clothes dryer <br /> 1Nater heater Ranc�e hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backllew preventor Heat pump <br /> Urinal Unit nealcr <br /> Crinking Fountain Boi�er <br /> Floor drain Retrigeration <br /> Greasa irap Woodstove <br /> Ruof drains Other <br /> Other —�— � <br /> — 1_J���-� —' C� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hr.roby corili(y that I havo read and examined this application and know lhe samo lo be true and correcL All provisions of laws and <br /> ordinaces governing this typ�of work will b:�wm�lied wilh whether speci(ied herein or not.Tho cranting of:+permit does not presurne <br /> to give auliionty lo violate or cancel tho praaisinn of any olher state or local law iegulaUng constn�ction or tho periormanco o( <br /> conslruction.That I am aull�rized by lho owner of this property lo pedonn the work forwhich applicalion is made and I comply wilh the <br /> Sl o ctors / 1 . RCW and 296.200 WAC. <br /> / � ___;� <br /> SignaWre of OwnedContractodAuthonzed Agent Dato Z �� <br /> Z <br />