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r , <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEi�VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everethva.org <br /> �j APPLICATIONS ARE 4CCEPTED FROM B AM TO 4 PM j��7�-C�� <br /> SITE ADDRES �I� DI � �n ' PARCEL TAX I.D.# P��O��_O�� <br /> K/ "f p <br /> LEGAL LO 0. BLOCK TFACT Ofl SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PH6NE {�5; <br /> � )aS(Nl �iD�l i ( ?� Ma�lv� c l�a. l�v.e� �i/�� 982U 3 z93•a y 3s <br /> TENANT NA� ME—� CO ACT FOR PERMIT PHONE� .G11�7, 8'L(pZ <br /> N � VOV4V� E•MAIL NXDG D�N�� 1 <br /> �C NTRACTOR ADDRESS CITY/ZIP PHONE <br /> ��°�lYl:u°v) l�I�G1vl.�J(�f'1�- �� n,�r I/ 0��-eGhvL„-v� �npQ,�2C¢, 2pTo��k�l• �o�oi a . <br /> NTR.L ENSEN��/ •�P�I`TI(�D /IV-P/ N "ISI%� <br /> USE OF BU�LD�— HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��(,/�� �/✓U�l� rP�J�""""� _Elec�ric _Gas_Other <br /> u I <br /> WORKDE�I�IPN „ ' �G���� � �iWl�/ �7C/!(/v'�.� �Irw {'""„ `^ <br /> (/�1� <br /> `jrv�,i' <br /> ,4 7 �o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lava�ory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Wa�er heater Range hood <br /> _ Sink(service;bar/mopie�cJ Exhaust fan <br /> Back(low prevenler Heal pump <br /> Urinal Uni�heater <br /> Drinking Founlain Boiler <br /> Floor drain Re�rigeralion <br /> Grease trap Woudslove <br /> Roof drains ��� Other <br /> � Other INQ�/Y _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritity that I have read and examined this application and know�he same lo be Irue and correc�. All provisions of lavrs and <br /> ordinaces goveming this rype o(work will be complied wilh whether specdied herein or noL The granling ol a permit does not presume <br /> I to give authori�y�o viola�e or cancel tl�e provision of any other slate or local law regula�ing construction or lhe pedormance o( <br /> construc�ion. That I am autl,orized by the owner of this property to perform�he work tor which applicaiion is made and I comply wi�h�he <br /> Stale Coniractors Law 18.27 CW and 296.200 WAC. <br /> .I�c,t`����-`�,r�l�csrm ,�1��ir� s���,/a8 <br /> Si'nature o OvmeuContractor/Authonze A ent Date <br /> �— <br />