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� u � 7 <br /> - - �,-_-1 <br /> PER;MI� APf�LICATION <br /> � CITY OF 1-uERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-88^0— FAX 425-257-8357—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> - a �/ � � o o y t ��� 6 � �o o �J���,- l2- <br /> LEGAL LOT NO. L3l�JCK TRACT <br /> DESC. � �r � p <br /> OWNER ADDRESS CITYIZIP PHONE <br /> .1 m mC�n �� C.O�u�.-�., aS a � �v►�.b�� /•l�ve. �'�P <br /> l"ENANTNAME ^ CONTACTFORPERMIT PHONE <br /> L m ,�r�nu� �,av"cR. l� �x i P C�. l/rn�! aS38�� 9 F�998x io0 , <br /> CONTRACTOR ADDRESS CITY2IP PHONE �ZS 3 <br /> ��re �ync!-rnics ,.�n,e �� � ax�a3� k'e�Q�o �q� p- <br /> CONTR.UCENSE# ��w r o� 9�� I <br /> USE OF DUIL�ING HEAT SOURCE I C1ONTRACT PRICE OF WORK <br /> / /1 r� i) _electric _Gas_Olher I ..p �/ �O b <br /> l�h G�G` � � <br /> WORK DESCRIPTION <br /> s d15t�R �.�.� f.�. �p�� ,.�e..�..., s�St�.»�. � �Q � o�a i i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash besin) Gas piping <br /> Shower Water heater <br /> I<itchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cblhes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> ' BackOow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drzin Refrigeration <br /> _ Grease trap Woodstove �i� <br /> Roof drains � Other_FJ Z <br /> I _ Olher -- — _C� ` �D�yl'� <br /> -r <br /> CITY OF EVERETi LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corre�:t. All provisions of law=and <br /> ordinaces yoverning this type o(work will be complied with whether specifed herein or noL The grantinr,of a permit does not presume <br /> to gi��e authority to violate nr cancel the provision of any olher state or local law regulating constructio��or the performance of <br /> consiruc�ion.That 1 am aulhorized by ihe owner of ihis property lo peRorm ihe work�or which apr!��:ation is made and I comply wilh the <br /> State Cuntr tcre Law 18�7 RCW and 296.200 WAC. <br /> � �.�Z.� � -��-o_� <br /> Signature f wnedContractorlAuthorized Agent Date ' <br />