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, — <br /> + �PERMIT APPLICATIC�N <br /> CO a,da��s5 ��'��' �CITY OF EVERETT PERMIT SERVICES <br /> •� � �j 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL T/ll(I.D.# PERMIT A <br /> � �/ ��/Pie ,,v Mo5 i�-053 <br /> LEGAL LOT NO. BLOCK TRACT Lr z��— Zd�g U <br /> DESC. �.�, �Lr 9�/-3 4�31 <br /> OWNER o,�,,,��K,,,,�P�,y�,,�SGGL AUDRESS CITY2IP PHONE <br /> �/ /i/lilr9 -z-ti 5 e✓h�-�f �.Q rL,✓.s�w� �F�f <br /> TENANTNAME CONTACTFORPERMIi RHONE <br /> �/`y�///!�/ <br /> CONTR CTOR i�7/��� U/� �T/� ADDRESS �` CITY2IP PFidNE ,J—,�u �/S <br /> � �1 �/1%�f�y.�s /1 !c �U��. r <br /> CONTR.LICENSE# �i uv��^� <br /> Il i//i,��/19�i�'I'�:f2� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �C ,oy� �� _Electric �Gas_Other �'�v �J� j <br /> Z <br /> WORK DESCRIPTION <br /> �� ���v2 CJ X�S f//uf U/t�/ / Gt CA'/L'/'S �'�rJ/E/d/�C e <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _� Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 dis�osal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(senicebar/mop/elc.) Exhausl fan <br /> Backflow preventer Heal pump <br /> l;rinal Unit heater <br /> Drinkinc� Founlain Boiier <br /> Fioor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Otlier <br /> O�her <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined lhis applicalion and kno�v lhe same to be true and correcl. AII provisions of laws and <br /> ordinaces governing Ihis type of work will be complied with whether specified herein or noL The granting o(a permit does not presume <br /> to give authorily lo vioiale or cancel the provislon of any other slale or Ioca�law regulaling conslruclion or the perfortnance of <br /> construction.Thal I am aulhorized by lhe owner of this property to perform the work for which application is made and I comply wilh lhe <br /> State�C iractors Law 18.27 RCW and 29G200 WAC. <br /> �%%������- <br /> Signature of Owne�/G'ontraclodAuthorized Agent D�le <br />