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�-�u _ o� � <br /> P RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � <br /> i � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> ILOS EASTCAS1Nb R-D oc3 3Gceye �Zoo I <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. Q EVERI.�f Nnnne TRAcTs p�- v 1 <br /> OWNER ADDRES$ CITY/ZIP PHONE <br /> H�r�ck 4�Tr+eQs Non�Es 3922 �+��ti, AvE.��E Euc�acTz `�d2oSy2S3�1-�360 <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> . � . Soel W4Q�tk 425- 290-242�f <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> NA'Nt�C aR�'ilf't'RS �MES 392z g�+�A��. l� �E . . . . . . , <br /> CONTR.LICENSEP E V E`{i C T T ��2�5 l Z.S - 3�q �'� 3 6� <br /> 1-���K R� ol 2�Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� _Eloclric �Gas_Olher Cf � `��K <br /> WORK DESCRIPTION <br /> S�k ���,� r3 A s z� I '10 <br /> OS-o11 <br /> PLUMBING ---}II- MECHANICAL <br /> NO. TYPE OF FI%TURE UR ITEh7 I NO. TYPE OF FI%7URE OR ITEM <br /> � Toilel A/C-alr handlin�unils <br /> Balhtub � Forcod alr systems <br /> � Lavalory(wash basin) `L Gas piping <br /> / Showar �_ Watcr heater <br /> �— Kilchen sink 8 disposal / Gas lireplaco <br /> -T Dishwasher / Gas range <br /> � Clothos washer L_ Clolhes dryar <br /> Walerhoalor L Rangehood <br /> _ Sink (service/bar/moplelc.) � Exhausll2n <br /> �ackflow prevevter _ Hea�pump <br /> Urinal Unil heater <br /> Drinkin�Fountain _ Boiler <br /> Floor drain Rehigeralion <br /> Grease lrap _ Woodstove <br /> Roo(drains Other <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3108 <br /> I heroby ceritily ihal I have read and examined Ihis application and know the same to be lrue and corre:l All provisions of laws anA <br /> ordinaces guvernin�lhis typo o(work will be compliod wi�h whethor spttcifiod herein or nol.The granling ot a pertnil does nol prosume <br /> to give authorilv to violate or cance tho provislon ol any olhor stato or local law rogula;ing construclion or the pedormance of <br /> conslruction. at I am authorized ho ownar oi Ihis property to peAorm the work lor which application Is made and 1 comply with ihe <br /> St t ,,.-w RC f 6.200 WAC. <br /> � natur ol OwnedCon r t r/ ulh ized Agent Date -- <br /> y <br />