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� <br /> F .�RMIT ��F'PLICA�'f�.N <br /> CITY OF EV�RE.TT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98'�01 <br /> 425-257-8810— FAX 4?5-?57-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8!aM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADURESS /3£dL7 Z s-r� 3/� PARC[L TAX I.D.# PERMIT# <br /> /��C�U S� ��l/G1i�� ��/�1�: c+'1 32&��`-3- u23� aec. ; Sdsio -o�u <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ��4I•L-� %� � I <br /> OWNER A�DRESS CIN/ZIP PHONE/_�QD_��J- <br /> j ;J��� � /'�G U�l��r c c Cvz� �� �Sa� fl�-h'�t!72 M��lf,f�r� �.��l��c,��o, cv� �c z7S <br /> TENANT NAME CQNTACT FOR P[RMIT PHONE <br /> !�A->S/-}uG� sYs%h/"t��t C'iNa j�7ti� CaNr�r�z/�c`-:,i�,ti' l7�'_ 91�"(�;o_ .'7 � <br /> CONTRACTOR y� -�q�,�•���(� �''�v�;,4-. ADDRESS ) z-� I�(�'"����c? 7Y P PHONE `L L"� <br /> /�j✓�(7 I�� �_I�V. �t - <br /> ����c'.}� ���� ��•,�C l�-�= c- �r� <br /> CONTR.LICENSE# ���1��ITj 7��K- ��{��I ''L``` <br /> USE OF BUILDlNG HEAT SOURCE CONTRACT PRICE OF WORK I <br /> �Jj�%Ce/ �7G�1%�t� %���A�����7 _Electric _Gas_Uther ��7��/'�` <br /> WORK DFSCRIPTION <br /> 1�C�I�u��iiic�n�' �/�/LI�v �/�.�7/3T"��T7L Gt�l�ZGS ����G/%� <br /> PLUMEING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handling unils <br /> Balhlub Fcrced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 3 disposal _ Gas freplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmopletc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urina� Unit healer <br /> Dr�n�cing Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Othar <br /> i I -- — — <br /> i <br /> I I CITY OF FVERETT LOCAL SALES TAX CODE IS 3105 <br /> i <br /> � --- <br /> � I hereby cerili(y that I have read 2nd eramined this application and know the same to he true and correct. All provisions of laws and <br /> � ordinaces goveming lhis type o(work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authoriry to violate pr cancel the provision of anv other stzte or local law regulaling conswction or the peAormance of <br /> � onstruction.Tnat I am au horized by lhe owner of lhis property to periorm !he work for which application is made and I comply wilh tiie <br /> Stale Contractcrs�aw 18. 7 �id 2 ;200 WAC. <br /> '� "��� 7 !l, �- 5�- �5� <br /> Signature of Owner! ntrac o A orized gent Date ��a; <br />