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l <br /> PERMIT APPLICATION , ,, = <br /> CITY OF cVERETT PERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-88i G—FAX 425-257-8857—wuvw.evereV00Yp�g <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S�dG��R�U�I" Gth W0� 2�-go��Tv�aa31«-� �JU-10�-t-00°� <br /> LEG LOT NO. BLOC TRIICT <br /> DESC. <br /> OWNER ADDRE88 CITY2IP PHONE <br /> 5�-� ����� l�G<i � C�e� w� �vv� 9��aY <br /> TENANTNAME CONTACTFOR ERMIT PNONE <br /> kl�� f�n��, �3 �'ll ��r�� � 3G�-�2�c-�3�s— <br /> CONTRACTOR ADDRE S CITYILP PHONE <br /> vrt�Y.�.rs�y� 3-l��ut�,s�+� .�6a8 (�wY 94 5«,�� �_ qzq -�3�3 <br /> CONTR.LICENSE• �pU.�V,�'�V� (,v� q�'�'�2 <br /> 7 <br /> USE OF BUILDIN / Q I — HEAT SOURCE I CONTRACT PRI�F WORK <br /> / �. cn <br /> G'0.� W ElecUic _Gea Other �,�'� <br /> WORK� DESCRIPTION <br /> 1..t5t`�Jl�l � lN� St.�v� a�rc��e55J�1��2c`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toi@t AIC—air han0�g units <br /> —athtub Foroed air systems <br /> i avatory(wash basin) _ Gas piping <br /> Shower t ater heater <br /> hitchen sink C disposal Gas fireplace <br /> a ishwasher Ges range <br /> Clothes washer Clothes dryer <br /> i aundry tray _ oange hood <br /> Sink(servicelbar/mop/elc.) _ Exhaust fen <br /> —ackflow preventer eeat pump <br /> � rinal � nit heater <br /> arinking Fountain _ —oiler <br /> Floor drain aefigeration <br /> Grease Vap t oodstove <br /> 0 oof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 7106 <br /> I hereby ceritiry that I have read and examined this application and know the same to be true and corred. All provisions of lews and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not The grenting of a pertnit does not presume <br /> to give authority to violate or cancel the provision af any other state or local law regulatirg wnsWction or the perfortnance of <br /> construclion.That I am authorized by the owner of this property to perfortn the work for which applicatlon is made and I wmpty with the <br /> State Contra�kors i aw 18 T oCt and 296.200 t AC. <br /> �.�,�--��� �'-z-�� <br /> Signature o Owner/ ntractod uthonzed gent et <br /> ,l Z <br />