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( <br /> PERMIT AP�LICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �-'�D� <br /> S�TE ADDRESS �� . PARCEL TAX I.D.M PERMIT/ <br /> c �n��i s-t- ooy 7� - 23 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION N � � <br /> oesc. - 10 � � 2 � EVE�/%sut;/�iViS�ON 'O <br /> OWNER ADDRESS CITYZP PMONE <br /> /� / n C �)sy.s-a��y <br /> /CA✓E�l/ LtJ.�NC'TS �-t�/SR�JCT�oA� /S// /I�.SS!-�i� SEA%/Cf(�i4gq/�3 <br /> TENANT NAME I ONTpCT FOR PERMR _ PHONE g'Z S -LS� '`�Z V L <br /> .'4.-/>i��. <br /> m(� i-} 'a��rv <br /> �� Im�rc•r.,oni���„cj., �`� <br /> E�IAAIL N.�*�+•. � � �G . <br /> ,4v�N :N�nJ� S C,v2�ii�V��•1J �.S I/ iJ � SS�IS� .�RllLE`��3 206)SYS—ztJ�y <br /> CONTR.LICENSE/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _ � I _Electric �as /� Olhar <br /> WORKDE9CRIPTION � AS I C- 30FS <br /> � .uti �T � , <br /> --c, - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � � Tollet A/C—air handlirg units <br /> _� Bathtub Forced air systems <br /> � Lavalory(wash basin) � Gas pipfng <br /> Shower Waler healer <br /> � Kilchen sink 8 disposal Z Gas flreplace <br /> Dishwashor Gas range <br /> � Clothes washor � Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/alc.) � Exhausl fan <br /> BacMlow prevanler Heat pump <br /> Urinel Unit healer <br /> _ Drinking Fountaln Boiler <br /> _ Floor drain � Rofrigeration <br /> Grnase Irap Waodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby coritiy that I havo rcad and examinod lhls applfca6on and know lho same W be lrue and cortecl. All piovislons of laws and <br /> ordinaces goveming this typo of work will be complied wilh whethor specified herein or not.The granling of a pertnit does not prosume <br /> lo give authority to violate or cancol lhe provlsion of any olher slale or local law regulatlng construcdon or lhe performance of <br /> construction.Thal I am authorized by the owner ol this property to peAorm Ihe work for which application Is made and I comply with itie <br /> Slate Conlractors Ln 18.27 RCW and 296.200 WAC. <br /> ,J �/-�9_ 07 <br /> i�Sig a ure of or/Conlraclor d Agenl Dale �'L <br /> � <br />