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� _ �S�. <br /> PERMIT APPLIGATION <br /> CITY OF EV�FcE'T'T PERMIT SERVIGES <br /> 37_UO CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-�+nvw.everettwa.org <br /> �� I i� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRES�S� PARCEL TAX I.D.p PERMIT N <br /> �-���o C.0��7\ Mt)�U _-f ) �] <br /> T <br /> LEGAL LOT NO. B�OCK TRACT <br /> �ESC. <br /> OWNER ADDRESS CITYlZIP PHONF <br /> Lv�a�ri 5'c�1�� b,�- "- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �vciz�7�- HicH �i�c�c�c ��=u `,� � (yZs� 2�, z - 31ry <br /> CONTRACTOR AODRESS �/� n CITY2IP PHONE <br /> CV(_IZGIZ(.l-.hJs`�"`�ZE �"4lJ'AT ti ��C 212u Y'f1Cl�Flt L � `7�SZClI (4)2�2-"il(y <br /> �ONTR.LICENSE p <br /> L- ���z6sSozzu�r <br /> USE OF BUILDING HEAT SUURCE ! CONTRACT PRICE OF WORK <br /> �,�� ��_,L _Electric �Ges_Other � Q� D-U <br /> WORKDESCRIPTION CKkhUS'r (},tC='lN(:%� OYJ ��T��1L� I�A.�,` N�c�u�S � utuT��-rl <br /> (�� �''l,�l�'t � ���Ct 1i.toh���lL�4ilL�Jj � <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> BatMub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> Laundry Iray Range hood� <br /> _ Sinh(servicelbar/mop/etc.) � Exhausl fa�Rtp��� <br /> Backflow prevonter Hea[pump <br /> Urinal Unit heater <br /> Orinking Fountain 8oiler <br /> Floor drain Refrigeration <br /> Greaso trap Woodstove <br /> Roof drains Other <br /> Other_ �1ACT o0i �C.1Tlc�.J <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 71 DS <br /> I hereby ceriC�ty that I have read and examinad this application and know the same to be true and wrrect. All provisions of laws and <br /> ordinaces goveming Ihis type of work vnll be complied with whether specified herein or not.The gran[ing of a permit does nol presume <br /> to give authonry to violate or cancel tho provision oF any other state or local law regulating construdion or the performance ot <br /> construction.That I am authorized by the owner ot this property m perform the work for which apptication is made and I wrnply with the <br /> State Cont ctors Law 1 7// W a q6.200 WAC. <br /> ���..(�a�i�! .1 -'�S - (i T <br /> Signa ura of Ovmer/Coniraclor/Aut ed Agent Date <br /> L <br />