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—� — <br /> PERMIT APPLICATIO�1 ., � �� "�' <br /> CITY OF EVERETT PERMIT SERUICES � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./ ERMIT• <br /> I ( (DS �V eN wa DO 90o pp oo � ��� ` S� <br /> LEGA LOTNO BLOCK CT <br /> oEso. � 3 G�irv�noun�' <br /> ONMER ADDRE88 CITYILP PHONE <br /> �d�r�rAT�er�i e� �l.G 2�2`( �Z "r hve . y�. IDa �verei�- qeZvl �E'15.33q '� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> yab -n.�Q; �y{�At,1YGrt I g�mdra f�l�ev �25 317 -50�1 <br /> CON7RACTOR �r7 MDY eh�j��/} ADDRESS - / CITY2IP PHONE <br /> g ��-���a _� ,���<<� �:��i <br /> � L� .��`CONTR.LICENSE• oY e� � D 33 N � ( �,,� �.;� � �- �2��`�23 ' 5313 <br /> � M 9 .► y ,�: �>> r <br /> US€OF BU ING HEAT SOURGE CONTRACT PRICE OF INORK <br /> -- -Tha� �es-fz+ur'aat or� <br /> — Ge�eva( �-F�ai � I _eie��� �85_ou,e� �26�0 <br /> WORK DESCRIPTION <br /> Got+sf'►'ci�{' G{Evwisi�9 wall � y�ew P�cfcVior ,�oar , 5�an�-e ele�. �r � <br /> (j1ko 2 pahc°.ls � �ir� �uKt►�Ql yyskew� �h+a 2 5y�'ew�s , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavetory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> � Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray _ Range hood <br /> Sink(service.barlmoplelc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinat Und heater <br /> Drinking Fountain Boiler <br /> Floor drain Refigerabon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CI7Y OF EVERETT LOCAL SALES TAl(CODE IS�106 <br /> I hereby ce��liry that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grentlng of a pertnit does not presume <br /> to give authori to violate or cancel the provision of any other state or local law regulating consWction or the pertortnence of <br /> con ru ' - h I m uthorize y the owner of this property to perfortn the work for which epplicatlon is made and I comply with the <br /> Slat o c� L 1 . 7 W and 296.200 WAC. � <br /> � �/� ' <br /> Signa o ner! o actor/Authonzed gent ate � �C`/� ' �/Z <br />