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I <br /> , <br /> -� -� I <br /> , PERMI�' APPLICATiON <br /> CITY OF EVERETT PERWIIT SERVIC�S � <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425 257-6857-www.everetta�a.org <br /> ��appPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SRE ADDR PARCEL TAX I.D.1t �R��Z J <br /> I��Gi2EEn� t�.� oo3q32vo/oo /o 0 <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. ( <br /> OWNER ADDRE55 CRY/IIP PHONE <br /> /�s�w �asr �c. �io� MLK Si. (.JA S. So-n-r�� WW- q �� l� <br /> lENANTNAME I CONTACTFORPERMIT PHONE <br /> 'I � �iG�c �C oG� '�LS-26S-ISlo-7 <br /> (�,,tssy /7�+ i �- <br /> CONTRACTOR • ADDRESS CITY(LP PHONE yiS-zes-ISG� <br /> =N-c�.v.ar..ia-�� 5��.. �-. 12y l�l t-�`,'`t 4��Z Ev��EGr7 `c,.)A- <br /> CONTR.IJCENSE M 7 82� 7 <br /> SN-tz RSG9'"�4Qk- <br /> USE OF BUILDIYG I HEAT SOURCE I CONTRACT PRiCE OF WORK <br /> � <br /> /+ Electric Gas Other 7��� _ <br /> LO in IK E�'1 iC 1�'41- �_ �_ <br /> WORK DESCRIPTION <br /> Zr.s�a�l�.�S C,t-o�.s�.c 5'�S.-.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR fTEM NO. TYPE OF FIXTURE OR fiEM � <br /> Toilet _ AIC—air handling units <br /> Bathtub _ Forced air systems �� <br /> Lavatory(wash basin) __ Gas piping ! <br /> SMwer _ Water healer � <br /> Kitchen sink 8 disposal _ Gas firepiace <br /> — p���ef _ Gasrange <br /> Cbthes washer _ ClotMs dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbadmopletc.) _ Exhaust fan <br /> BackAow preventer _ Heat pump <br /> Urinal _ Unithea4er <br /> _ Drinldng Fountain _ Boiler <br /> Floordrain _ Re6igeration <br /> Grease trap Woodstoves15� <br /> Roof drains _L Other „E�_ <br /> Otlier — — <br /> CITY OF EVERETT LOCAL SALEu 7AX CODE IS 5106 <br /> I hereby cerifify that I have read and examined this appliation and know the same 4'�be true and eoned All provisbns of Wws and <br /> ordi��aces goveming this type of v+ork will be complied with whether specifiad herein or not The granting of a pertnit does not presume <br /> to give authority to violate or wncel the provision of any other state or local law regulating construction or the performan�of <br /> co�struction.Tha[I am authorized by the ovmer of this property to pertortn the work for which appGwtion is made and 1 comply with the <br /> ,State Contra ors LaK�1827 RCW a .200 WAC. <br /> � Z 23 OS � <br /> SignaNre of OvmedCon7actor/A nzed ent ate �/ <br /> Zi <br />