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PtRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—�wvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADL RESS � PARCEL TAX I.D.P P�RM T# <br /> 4%Il CAST'�E LAn�c � � � � '- �U <br /> IEGAL LOT N0. BLOCK TRACT <br /> I DESC. <br /> � OWNER ADDRESS CITYlZIP PHONE <br /> L/tilDA NAlL- S�71/ c�s7lt �n1, rdrnEi,' _ <br /> TENANT NAME GONTACI FOR PERId1T PHONE <br /> n��,� /l�A�a y �/�25-87a -/��fo <br /> CONTRACTOR � AOORESS CITY2IV PHONE <br /> mA[ay Cd�STit[�cT/a•J � , � /hSU[. �18.i�/ � .36d �65Z-772L <br /> �s.L o2N4 �. �� <br /> CONTR.LICENSE a ��AL4 yC -d 7 %4 fI G/L �eI,S 'FlJQ -��G� <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> 5 _Eloclric _Gas_Other oZ..2 �Q w <br /> .F. �. <br /> WORK DESCRIPTION <br /> RE�A�2 S { iM��auEr�d�Ts T� Exar��r� �nnlo9Tid,l <br /> 7� ,�s i.op�cF , <br /> ����a, .7'�8 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUR[OR ITEM NO. TVPE OF FIX7URE OR ITEM <br /> Toil��t _ A/C-eir handling unils <br /> Balhtub Forced air systems <br /> _ Lavatory (wash basin) _ Gas piping <br /> Showcr __ Waterhoalcr <br /> Kilchen sink R disposal Gas firepiace <br /> Dishwasher Gasrange <br /> Clothes washor Cl��hes dryor <br /> Wator healer Ranc�e hood <br /> Sink(servicr,�badmoplelc.) _ Exhaust lan <br /> Backllow preventer Hea�pump <br /> Urinal _ U�iit heater <br /> �rinkiny Pounlain Boiler <br /> Floor drain Rofrigeralion <br /> Greaso�rap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY O� EVERETT LOCAL SALES TAX COOE-��3105 <br /> I hereby ceri�ily Iha�I have rr.ad and examined Ihis :+pplicalion and know ihe same lo be�rue and correct All provisions o(laws and <br /> ordinaces yoverning Ihis lype o(work will bo romplied with whelher specified her�in or not.The pranling of a permit does nol presume <br /> to c�ivo authorily lo violatr.or cancel Ihe provision o1 any other stale or local law regulaling consir�ction or lhe periormance ol <br /> consfruclion.Tha�I am authorized by Iho owner ol this property to peAorm the work for which applicalion is made and I comply with the <br /> Slato Coniractors Law 18.27 RG1M1' and 2�6.200 WAC. <br /> � <br /> /u -3i - a6 <br /> SignaWre ol wnedConirac r/Authorized Ac�onl Date <br /> I�Z <br /> ---- _ _ _ - -- ----- ------ <br />