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i <br /> PERMiT APPLICATION I <br /> CITY OF EVERETT PERMIT SERVICES I <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857 -www everettwa org <br /> '�'�-+n_ .�r� :— APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � — - --- — <br /> I SITE ADDRE55 FARCEL TAX I.D.M PERM T p �, <br /> � 30 3 ,c �� r.G c� x �o�/ � �•�� <br /> i LEGAL LOTNO. BLOCK TRACT <br /> i DESC �p �4}��f��a _ <br /> sz..._��u�.�, � <br /> OWNER ADDRES CITYIZIP PHONE � <br /> t�'���I1��1'l�_-1p��1�1�in3Al4�a r��IG�- Uoy��,g�o 1 L <br /> II TENANT NAME CONTACT FOR PERMIT PHO E I <br /> u�a-�Il�z-3�� <br /> CONT�T� A��� CITY/ZIP PHONE <br /> � ai�W�orw�G,rE��vx,h� Co. �v,e.. S��o �1W" Klvc .`� , �'+a�+c ,w�t ��06 Za,,-�mZ-3�� <br /> �, CONiR.UCEN EI <br /> � -- �tvTl-1UCf 1�loP�T <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK � <br /> �+(�`� ��-- -- ✓GlecVic __Gas_Other 4 Z 0 i OGO �U� '. <br /> I <br /> I WORK DESCRIPTION �, <br /> �ucid,n� �vu ru,w Y.�ShaomS a�+� �.u� d��ti:kNoY� FzY a`r ' <br /> �,d Il.u,fiv�q � ' <br /> PLUMBING MECHANICAL �, <br /> I NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM '�� <br /> � Todet _ A/C—au handling umts � <br /> Bath�ub Forcetl air syslems <br /> � Lavatory Iwash bas�n� Gas piping �. <br />�� Shower � Water heater <br />� Kdchen sink 8 disposal _ Gas Lreplace <br /> Disnwasher Gas range � <br />� Clothes washer Gothes dryer <br /> Laundry tiay Range hood � <br />� Sink�servicelbadmop/etc I � Ezhaust lan � <br />� Packflow prevenler _ Heat pump <br /> Unnal Und healer � <br /> Drinking Pountain _ Boile� <br /> Floor diain Reingeration <br /> Grease Irap Woodslove <br /> Roof drains Other_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS]105 <br /> I hereby cen6fy Ihat I have read and e*ammed Ihis aUPlicaLon and know Ihe same to be Irue and correcl All provrsions of laws and <br /> ordinaces govermng Ihis lype of work wdl be complied wdh whether speahed herein or nol The g�an6ng of a permR tloes not presume <br /> lo grve authordy to violate or cancel the prov sion ol any other state or local law regulahng construchon or ihe perlormance o� <br /> consiruction That I am authonzed by ihe owner ol th:s���ropeity to Perlonn ihe�tioik lor which applica0on is made and I comply wdh Ihe � <br /> ' State Coniractors Law 1/p/2 RCW and 296�OO VJ�C <br /> ^__ L <br /> j � r t�-� Iif3�oLP <br /> , <br /> ' S� B O 1N 1 ....M1.1�L,r n p ..� 1:IL <br />