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�. _ - _ _- - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> _ - _ - _ <br /> SITE ADDRESS PARCEL TAX I D. R PERMIT# ! <br /> 300 3 _W l�nsinlo � �-G 3 0_1____. 180 80�-oZ,S � <br /> ..l_Fi;��l I LOT NO. .. ._ . � BLOCK-- � TRACT OR SUBDIVISION p -- ��--�-- — -- ` ---- _-- I <br /> C)FtiC ( <br /> � OWN R ADDRESS CITY/ZIP PHON- <br /> 3oE,�c, �oN, p�,�,� �o .�3ox ��o�Ms � Foy _�nZc y�� <br /> --- _ _ ---- -- ----------- ---- —-- <br /> � TENANTNAME CONTACTFORPERMIT PHONE � <br /> E�MAIL <br /> �' f.ONTRACTOR � � � AODRESS � CITY/ZIP PHO—� � <br /> UN�vEusir� �yl�u�• i/Gii �z���xf r✓ �yu�r�rrta �oG- 3G¢-y4'io <br /> , CONTR. LICENSE��7 .(��a75 <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � (�.0/'� (� F_'ci.�n� Gds O!h�r �����Q � <br /> I WORK DESCRIPTION l�i�)� EXi ST L�-riGT V 1NS7'»tt A/67Y)� �Jl/SN<�)TFy /S;�c�o,�/ <br /> ' ���lo cXrsT�Ni�rlWArr�Z /�flrc�z .o tic� �.�t CZJ NrxJ u/arz-�z <br /> I �qTD25 . • <br /> �c'Y»v c"�'/sTin/C1 Fiu�Ze-�z Y ,c�r� G.tiww�+eE�ni�s �Cf�.x/. A�/��/s�cL Nr h/. <br /> PLUMBING MECHANICAL <br /> �� NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � __— ___- . _. _ _ ___—_ —. —_ <br /> Toilcl _ A�C-ai�handling units <br /> Balhtub _ Forced eir sysl�ms <br /> .. - I_�valory Iw�ish b:isinl __ G�s piping <br /> Shuwer W��('f I1F�1P.f <br /> f!dchnn sink 8 dispnsel Gas freplacc <br /> � (�ish�v�ishor � _� Gasranye <br /> i:lulhr,s washcr _ Clo�hes dryer <br /> � VJ,der healor ._ Ronye houd <br /> Q i Gnk Iservirc�bAdmap�e�c ) Fxhtws�Idn � <br /> IH;�cAllow prm�ntor Hna�pump � <br /> Unnal __ Unil hea�or <br /> f7rmkln� Pounlain �uiler <br /> Floordram �_ Refngerahon � <br /> Grcasc Ir,q� Woods�ove �. <br /> Roof drani� Olhrr � <br /> � nu,ei �E /✓J.�c,u. --- _ _ - --- - ' <br /> -- _ _ _ —_ _ _- - - _ ___-- -- --- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hureby cori6fy Ihal I h�wn rread and egaminod lhis applicaUun and knu��Ihe seme tu be Irue and currer.L All pruwsions ul laws and <br /> �ndmares guvmnmq Ous lypn ul work will h�compli�d wilh whothor sper.iGnA harein or nnl Thr.yrantiny of a pnrmit doAs nol presume � , <br /> ���rpve aidhnrilv ���v . ., th��provision ol nny o�hF�r slalo ur luc.d law reyulahng�.onslruction or lhr, performance of <br /> � unshw.hun I ��m dulhu .d by Uie ownar ol Oiis prupr.Ay to��erf��rm ihi�wurk Inr which apphcahnn is madF� anA I r.omply wilh ihe � <br /> Statc C � ' � i' RC anA 29Q200 WAC. <br /> � o z aP <br /> Signalu e nl Ow .iTCn1R adorlAuthonzed Agenl Dale <br />