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� — <br /> I PERMIT APPLICATION B`p� ��'"" �r <br /> ' CITY OF EVERETT PERMIT SERVICES # B oso i� r� <br /> �I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 22Z1 C:"�/�R�`lT /1V� DOriG • L`Gr� -�olq -ca /,1� -�i-o� <br /> LE(GAL LOT NO. BLOCK TRACT <br /> DESC. ��{ � )o (�c G � �Do <br /> OWNER ADDRESS CRYIZIP PHONE C2vG� <br /> LA"l�1uN �^'+FG/O���lv,�� KC-� Z33R Il�r /Fvi: � f:,r.Tc� wA 2Yf� 2�S7 <br /> TENANT NAMF. I CONTACT FOR PERMIT PHONE <br /> rtiRVcs 1� �'� /�t=on y ��G) 3Gi - oo-� / I <br /> f,ONTRACTOR AD�RESS CITYIZIP PHONE I <br /> P��. s rnr=F m�c�.n�,c,n� i.vc. �'"�'�`,% J'� m,� r�c� <br /> CONTR.LICENSEq I�tt3�`yc si'T7c �G������ <br /> 9�/.tJ <br /> UE'iE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � ?� 2 yGe�. no <br /> Electric Gas Olher <br /> WORK DESCRIPT:�N <br /> n�VD11'Y R�klJTiNG O4cT/NG Sb /'17CL' T Nc7t� T('X/nn"r- C�nIF�Lui2�'T/��✓� <br /> �.�<< <.o�S n.oDi�✓� i�� iv�-�.� .ru/Fl-y G2,�c�t <br /> PLUMBING MECHANICAL II <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ AIC-air handling unils <br /> — g�p���� Forced art syslems i <br /> Lavalory(w� h basin) _ Gas piping � <br /> Shower _ Water heater I <br /> Kilchen sink 8 di osai Gas fireplace <br /> Dishwa:her Gas range I <br /> Clolhes washer Glothes Jryer <br /> Laundry tray _ Range hood <br /> Sink (service/barhno c.) _ Exhaust fan <br /> � Backtlow prevenl _ Heat pump I <br /> Unnal _ Unit healer i <br /> Onnking F inlain Boiler <br /> Floor vi Rafngeration <br /> G se trap Woodstove ' <br /> oof drains Other_ <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 1705 <br /> I hereby centity Iha�I have read and examined lhis applicalion and know Ihe same lo be Irue and correcL All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specifieJ herein or nol The granting of a permil does not presume <br /> lo give aulhorily lo violate or cancel Ihe provision of any olher stale or Iocal law regutaling conslruclion or Ihe peAormance o( <br /> consVuction.That I am authonzed by Ihe owner of lhis property to perfortn ihe work for which applicalion is made and I comply with the <br /> SWIe Cq�l ctors Law 18.27 RCW and 296200 WAC. <br /> 7r�"_ _ n r /Z 7 �05 <br /> � Signai o o( wnedConlractorlAutho ¢etl Agenl Date <br /> �-- - -- - - - -- ------ --- <br /> ►� <br />