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Ol ".S �201 :1 qUi: 15: I i PAC .7:':i 379 70d5 �t:1 '<ut.uf;31 �:as ['; Oul u0:1 <br /> • � <br /> ( . _— ..—___—� <br /> I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES j <br /> � 3200 CEDAR STREET, EVERETT, WA 9g201 <br /> I 425-257-8810 - FNC 425-257-8857 - �vww everethva org . ^ <br /> IAPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 P�d �(/� G�GL� <br /> IS17E ADDRESS PARCEL TAX I.D. C PER�AIT# <br /> � - a�/o� G'�u.e.. �Z3z � _� -o��+ _ '��4q� m �3��-c�sc� <br /> ILE-GAl LOrT1 NO. BLOCK TRACT OR SUBDIVISION a <br /> eesc J 1 �/8 oC�C r 5 � 5; r'a�r� 3(00 .-�Y�'__�_�I <br /> OLYNER �JJ L pDDRESS CIN/ZIP PHONE <br /> / �G-f� <br /> t���r,'�'s�l'Q , �� � / � C7yr-�.�1>>�1 �Ji/�� .J�' � � � <br /> 7ENANT'yAM1H 1E I CONTACTfORYERtd17 pHONC 1�ZS 3 �17-I / /�- <br /> �i-cr-c«.....�J .� E�R,AIL a��0���7q"iLfrQ�,Q�S <br /> CONTRACTOR��Q�,�:���� �`�`� 1 ^n qDOHE55 ���� ��J CI /ZIP N110NE � <br /> Ij S l',�,�a '�25 3�f 7./y/� . ,CoY') <br /> CONTR. LICENSE C �vn� -#'�� �v.e�w�" �-� <br /> /,J��1/ivcS f/3 G/) �}8'2oJ <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK � <br /> ' (o � � a �vo I <br /> Electnc � Gas Other <br /> WORK DESCftIPTION <br /> � <br /> �-.P,P(r�r�., ��,�-� � <br /> � PWMBING MECHANICAL <br /> INO. TYPE OF FIXTUHE OR ITEId NO. TYPE OF FIXTURE OR ITEh7 — <br /> 7odet A/C -air handling urnls <br /> I � Bathtub — Fo�ced air systems <br /> Lavatory(wash Uasin) � Ga;pipmg <br /> Showcr 1Nater heater <br /> I = Kitchen smk S dispo5al _ Gas firoplaw <br /> Dishwasher Gas range <br /> _ Clothes washer Gothes dryer I <br /> 'Nater heater — <br /> Sink (servicMbaRmopietc J — Ranye hootl <br /> Oackflow preventcr _ Gxhaust fan <br /> — lieat pump <br /> _ Unnal Und heater <br /> __ DnnAing Fountain [3oiler <br /> _ Roor tlrain Refrigeration <br /> ___ Grease trap Woodstove <br /> _ Roof drains — Q����� <br /> Other — --- <br /> CITY OF EVGRETT LOCAL SALES 7qX CODE IS J1G5 <br /> I hereby certify that I have reatl antl ezamined this apphcat�on and kno�v the same to be Irue and correct All proasions o(laws and <br /> ord�nances governing this type of work will be comphed with whether specified herein or no; The granhng oF a permit does not presume <br /> to grve authonty to violzte or cancel the prowsion of any other state or local law regulaling construction or the performance of <br /> �onstruc6on. That I am aulhorizetl by Ihe owner of thls property to pertorm tt;e work for which aOPlicat�nn is made and I comply wilh Ihe <br /> ;3te Contrac�ors Law t8 27 W antl 296.200 WAC <br /> ���_�.o E��i1 ��2�73 <br /> Signature of Owner/Contraclor/AulhonZed Agenl pa� I <br /> .'—. _..___—._—.----_—.__..__ I <br />