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PERMIT APPLICATlON 5-�3-�s <br /> CITY UF EVERETT QERMIT SERVICES J�'itr Jy/e�t,J <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /� <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org �-r/� (J.�L'��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOl'ACCEPTED <br /> SITE ADDRESS r PARCEL TAX i.D.A� P MIT 1R � <br /> T�b- c"%('C�� �. � �� , �:��'%t -�-_ : �i;' �_" ,� j% -- ' <br /> LEGAL LOTNO. � BLOCK TRAC7 <br /> oeso. D s or� nto✓N-�`t�a uie� �5� s c.a�sT2�" �sP <br /> OWNER ADDRESS CI7YZP fHONE 2S3•3g �rnU'I <br /> L.�'TI-ftlV�c f��t"1-oP r.t�T �-1-L P. c�. 3d1� 817 f`h1f3uWJ � v�4" �t$O7f-OSl7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �#�R�l6 C�1�— M�s I �� l�ss,�a�. �z�--�b6-7��9 _ <br /> CONTRACTOR ADDRESS CITYZP PHONE <br /> ��u-A.1 �e��.1�Rs,'�r�c, P. �. r�ox �� � noa� � nn4 9so-ri-o�,,�8 <br /> CONTR.LICENSEK Z`��'3��5�—�7� l <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> S2 � W t�,�ytpt(S'� _Eledric �Gas_Olher �Z� O� � �a <br /> WORK DESCRIPTION L�S�/= '� � <br /> 0, 000 5� uA'�vvi-�v5a f.��pin �.� �T'� <br /> �{-��f,o�. 27oi� 5F Mc�-z.A.�� Nr , S Sco sF aF o-FFrcE �D �ssac,ll4-7� <br /> 5�-r�e.�eYZ.I�- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTU2E OR ITEM <br /> � Toilet � A/C—airhandDngunits <br /> Bathtub � Forcedairsysi�ms <br /> � Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> I .Kitchen sink 8 disposal Gas fireplace <br /> I Dishwasher Gas range <br /> Clothes washer lothes dryer <br /> _, Laundry tray nge hood <br /> _ Sink(serv,icelbar/mop/elc.) � Ex usl(an <br /> _ _ BackAow preventer Heat ump <br /> Unnal � Und he fer <br /> Drinking Fountain Boiler <br /> _ Floor drain IM Refngeralio <br /> Grease trap WooAslove <br /> Roof drains Other <br /> _, Other � _ � <br /> — — � <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1 hereby ceritify that I have read and examined this application and know the sama to be lrue and corred. All provisions of laws and <br /> ordinaces ooveming this lype of work will be complied Hith whether specified herein or not.The granting of a pertnit does not presume <br /> to give autliorily lo violate or cancel the provision of any other slate or local law regula!ing conslrudion or the performance of <br /> construction.That I aulhorized by lhe ovmer of this property to perfortn the work for which application is made and I wmply wilh the <br /> State Conlr cto 27 RCW and 296200 WAC. — <br /> /�-�-- 3- ��-OS <br /> Signature of OwnedContractodAuthorized Agent Date �Z <br />