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�i .,oh <br /> ; <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVECES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FItOM 8 AM TO 4 PM ��7�,j <br /> SITE ADDRESS PARCEL TAX I.D.p /P�ERMIT k n <br /> I ZO�I ERSTCAS�-tJL (LC. UG39� (��)�yU I LO Q 1�17�7�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. � Li (3 E�E{�Y 1�1M6 "rRA C?S <br /> OWNER ADDRE_$S CITY2IP PHONE <br /> t-k��ck 6Qn����s NaMEs �122 $'1'�`A�f .I��E EUERETT 9�d2DS NZ5-397•736b <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> . . I5oe1 HaQc.1c 4t5- Z9o - 2429 <br /> CONTRACTOR ADDR�SS CITY2IP PHONE <br /> NR'1iCk C3RuZ1jCRS fk?MES .i`�22 01i1' Avt.u�E y�s- 3q�-'13b0 <br /> CONTR.LICENSE p �U F.'2�"['�' q gZ.nS � � <br /> HAACk�zd► z <br /> USE OF BUILDING HEAT SOURCE CONTRnCT PRICE OF WORK <br /> 5�� _Eloctric _Gas__Olher � � 3� ~ <br /> WORK OESCRIPTION <br /> Sh�� �lq�- f3A S Z C \"10 <br /> OS- oll <br /> PLUMBING MECHANICAL <br /> NO. TYPG OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C—air handling units <br /> Bathlub � Forced air systems <br /> � Lavatory(wash basin) L, Gas piping <br /> � Shower / Watorhoater <br /> �_ Ki�r.hen sink&disp�sal � Gas tireplace <br /> � Dishwasher � Gas range <br /> � CIoIhAs washor � Clothes dryar <br /> Walcr healor � Range hood <br /> _ Sink(servic�/barlmop/cic.) � Exhaust lan <br /> Bac4flow pievenlor Hoal pump <br /> Urinal Unil hoatar <br /> Drinking Fount2in _ Boiior <br /> Floor drain Re�rigeralion <br /> Gieaso trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TNC COOE IS�105 <br /> I hereby cerilily Ihat I have read and oxamined lhis application and know the same to bo true and correcl. All provisions of laws and <br /> ordinaces c�oveminy this type ol work will be compliud with whother specifiad herein or nol The granting of a permit doee nol prasume <br /> lo yive aulhority to violatn or cancol tho provision of any olher slate or local law regulating construction or thc peAortnance of <br /> conslruction. hat I am authorize b Ihe ow�nor ol this proporty lo perlorm the work for which applicalion is made and I comply with tho <br /> Sl. e Conira t s l. w 27 RC nd 29G.200 WAC. <br /> Sig aWre Owne /Con �o ulho ' genl Date <br /> �� <br />