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�— i <br /> PERNiIT APPLICATION <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM ���f� ._�� <br /> SITE ADDRESS 3 • C PARCEL TAX I.D.# � PERMIT p <br /> ,2� �nc�✓S�! �I�v�" . 'ZaC�{02O O�{.o 2�}00 S�)�L'-��I �%�/`� <br /> LEGAL LOT NO. BLO�K TRAC7 <br /> DESC. E P l✓„[ �.�!1/K 1 aiI I <br /> OWNER ADORESS GTY21P PHON6.�6 ��,�ZbZ <br /> L <br /> �c.ra.�;--�o�i� S��M �s LCC ll�`lo� Sa.�1� ��� Pk�;,i S�,�l1rl�/� 1�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l./ !�/6/GN� S��N� /�/0.i1� Vc.lc2�/lC �lz.� DS� ' ��� � <br /> CON RAC}'O /� / ADDR�E.5/5 / /CIT/JY/ZIF' PHONE <br /> ��� �/�Gs2 D/��l7/n �N(� GJ�6 �Y� /�CNW�^ / Y�� �'1/F� ��,fp.,.0� w� 99os3 <br /> CONTR.IiCENSE p <br /> /-�l�_PN s�oz .�/o S�zf &��3 - /ao � <br /> USE OF BUILDING I HEAT SOURCE ONTRACT PRICE OF WORK <br /> T a .-__ <br /> (�j���,�� � �Electric _Gas_Other !�i� - <br /> II WORK DESCRIPTION <br /> ,�/�;h;9y . Pv��/.��� �- y�u ���.o��, , ��� / ��.. /�-���u,.s <br /> PLUMBING -' MECHANI�AL <br /> NO. TYPE OF FIXTURE OR ITEM11 40. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> 4_ Lava;ory(Hash basin) Gas piping <br /> Shr,ver 7 Water heater <br /> iCitchen sink&disposal Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dr��er <br /> Lau�dry tray Range hood <br /> _/ Sink(servicelbadmepretc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> � Drinking Founlairi _ �oi�ar � <br /> Floor drein Refrigeration <br /> Grease trap Woodstove <br /> Ro�f drains Other <br /> � Other--,----- --- " <br /> CITY OF EVERETT LOCAL SALES TAX COD[IS 3105 <br /> II here6y cerilify that I have read and ezamined this appiication and know the same to be irue and co«ecL All provisions of laws and <br /> ordinaces goveming this type o�wor;�will be cemplied with whether specfied herein or nol The granting of a permit does nct presume � <br /> to give au;hority to violate or cancel the provision of any other stale or local law regulating construclion or Ihe periormance of i <br /> , consiruction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> I Stale Cor�{ra�lors 7fi.27 R and 296.2Q0 WAC. <br /> �Iv ��/, 6 <br /> 9'/�-o <br /> ', Signature o�0�ti dConlnctorlAufhorized Agent Date <br />