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-- - -- ,� ,���� ,��1 <br /> . P�RMIT APPLICATION . ,,,� �:� ,;���� <br /> CITY OF EVEF�ETT PERM�T SERVICES�; `•�`� .�C�� , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � � � <br /> 425-257-8810—FAX 425-257-8857—www.everethva.org ,,� . �" � <br /> � . ��: � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �{ "� 7 J � <br /> SITE ADDRESS - PARCEI TAX I.D.# PERMIT il , ��. <br /> 20�>3 I-IoYT ��cc�-� U��`l i70 �1 25 � 02 :Jo l� � �� _ _ ��i� <br /> I LcGAL LGTNO. BLOCH �A�T I, <br /> DESC. i <br /> OWNER dUDRE55 C17YlLIP PHONE <br /> ��sw`nr=n �kai5rl 6'lJanes p5o� +Y TM S7 evrcrrf, �A 4b�h <br /> I � <br /> TENANT NAIdE LON�ACT FOR PERMIT PHONE I <br /> $r.�� F�£rcNC2 <br /> zuc-683-evre <br /> CONTRACTUR ^['� ��STo•+� (�LpGS ADORESS �rT gpk 18?7 CI7YTP PHONE q,;o-S�i-9�77 <br /> ntqeysu�u� �i;�rr�� � <br /> cuHrR.ucENseu A��c� 61 99 tJ i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PR�CE OF WORK I <br /> �l�f/�oZ C�r S Electric _Gas_Other d / j� U�%J I <br /> — I <br /> WORK DESCRIPTION <br /> � �tir F2w��.c CicOc. �.� �t41 Cnwt k'ovL r T. �. 1 I S! O7�)4 <br /> ?� � ;� z�� r� P <br /> I PLUMBING MECHANICAL <br /> NO. TVPt OF FIX7URE OR ITEM NO. 7YPE OF f•IXTURE OR ITEh� I <br /> Toilet _ AIC—airhandlinguniLs I <br /> Balhtub _ Forced air systems <br /> Lavatory(vrash basin) _ Gas piping <br /> Shower _ Watar heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> DisMvasher _ Gas range <br /> Clothes vrasher _ Clothes dryer <br /> I _ Laundry Vay = Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust tan <br /> Backflowpreventr.r __ Heatpump <br />— I _ Unnal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Greaso Vap _ Woodstove <br /> Roof drains — �p1ef <br /> Olher -- ' <br /> � CITY OF EVERET7 LOCAI SALES TAX CODE IS 3105 <br /> I hereby cen6fy that I have read and examined this application and know the same to be Wo and conect. All provisions of lav5 and <br /> ordinaros governing this type of work will be complied with whettier spedfied herein or not The granting ot a permit does not presume <br /> �� ro give authonty lo violate or cancel iho provision of any olher state or local law regulating construction or the pertormance of <br /> '� consW cLon. That I am authonzed by the ovmer o(lhis property to pertorm tho work for which application is made and I comply with Uie <br /> ' St�te ontractors Law 1827 RCW and 296 200 WAC. <br /> �--t' � /�J ��� �� 3��o�. <br /> w <br /> `- Date <br /> �� Signatum of OwnedContrectodAuthonzed Agenl / <br /> 1 <br /> > <br />