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f � <br /> y <br /> � i <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 FM TO 4 PM �a —O g'�� <br /> SITE ADDRESS PARCEL TAX I.D.# �E�M��i 1 _ � I I <br /> �� I v C`(f'RCss � ,3 3 � 3� �1 «, a <br /> L[GAL LOTNO. � BLOCH TRACT }3��i��`Y /./lL��� �D/✓ E� <br /> DESC. �� (7- i J. — <br /> OWNER ' ADDRE55 CITY2IP PHONE <br /> �}�1/i2Y f-islf� {%_ ��I1� C�/ Pf��sS i=Ve�f� y�-s=513 - (,(35 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I �i�NA�� �f�:S- :_'3d-���?� <br /> ��/'�/�s�N tC i�1e'JtC/Nc/A�DRE55 CITY2IP PHONE <br /> CONTRACTOR <br /> S��wJ SCrSi)7it :-:C� SI�?/Tf/ ST S�/1"Tj� 'LG�' - :S�• l ' <br /> CONTR.LICENSE# �F;�r�Sh��/,/(�(� n��.�,� 5 G �r� <br /> r <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �t'-c����-./���(.�' I _ElecUic _Gas_Other <br /> WORK DESCRIPTION VC����`���, �yy �C IS IL� IC, f`�- � K�r=1 I <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXNRE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet AIC-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrenge <br /> Clothes washer _ Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Unnal _ Unit heater <br /> Drinidng Fountain _ Boiler <br /> Floor drain _ Retngerabon <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and Imow the same to be true and correct. A!I provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or Iocal law regulating consVuctlon or the pertormance of <br /> Iconstruction.That I am authorized the owner of lhis property lo pertorm the work for which application is made and I comply with the <br /> I State Contractors Law 1B27 R an 296200,WAC. <br /> � � U 11— 7 C� <br /> � '�CL i4_ � r. i'�4v� <br /> �ignatur of OwnedContra tor/F�f onz Agent D e <br /> - ---� <br />