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I --- - _ -- — — - —- — — <br /> �ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> I 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> il� — APPLICATIONS ARE ACCEPTED FROM 8 AiJI TO A PM <br /> i�1�- rw�zBtiR� <br /> SITE ADDRESS -t,�j'7�x' ��3I�O ��"�"�"� P� PARCEL TAX I.D.# PERMIT# <br /> 13 c� lc�iv�� da. us a, �73-�o�oo�3no ' � a - �o�-! <br /> L[GAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> o�s� i'� �v u. 'r+-� t���s No. 5 <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> !l7�z�i` GZ� <br /> ;-�TC,� j� �►�Golrb C.9Sig D� tiE M�YS�iuE li�h. a7� <br /> TENANT NAME CONTACT FOR PERMIT � PHONE ¢Z L�_�/ <br /> � .S,,2wwrE I �/A�Gfri� Tr('0�5�('luH1�' ,/l !rle=ic <br /> f �L(���L�—jj"—j¢(,��GJJ/ E-MAIL / I��117/L1RS� .l!/� JI7� <br /> CONTRACTOR ADORESS CITY2IP HONE �L f-_�S�- ✓ iJ <br /> G�l'"�NL�/ CG�'�?zlr�r'7D/V BYvs`d,eOA9l�{'�l� E�7, �k�o� �_,, ,p e•� <br /> I CONTR.LICENSE il <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5� r�� _Electric `�Gas_Other � '�z 7 ��V�y,�N <br /> WORK UESr,RIPTION /�E� S� 3_ �'� �od�A/-�/` <br /> J�'� 7sF ���/NGSP�-C� / l90s'.F <br /> , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> I � Toilet 9i' A/C–air handhng unils <br /> �_ Ba�htub Forced air systems <br /> I �� Lavatory(wash basin) � Gas piping <br /> � Shower � Water healer <br /> _� Ki!chen sink&disposal � Gas fireplace <br /> Dish,vasher � Gas range <br /> I�, � Clothes washer � Clothes dryer�� <br /> � �_ Walr:r heater Ran3e�ood <br /> � � Sink(service/bar/mop/elc.) � Exhausl fan <br /> � Bacicllow preventer _ Heat pump <br /> Unnal Unit heater <br /> Drin�iny rountain _ Boiler <br /> Flonr drain Refrigeration <br /> Grease irap _ Woodstove <br /> Roo(drains Other <br /> Other _ — <br /> CITY OF EYERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cenify lhat I have iead and examined this appliaation and know the same lo be true and correct. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a pennit does not presume <br /> � to give authonty to violate or cancel the provision of any other state or local law requlating construction or the performance oi <br /> constroctio�. That I am authorized by the owner of tnis property to perform the work for which applica6cn is made and I compty with the <br /> State Coniractors Law 18.27 RCW and 296200 WAC. <br /> ; /C;��i- /u-.?�-l�-iC <br /> Signature of Owner/Con�ractodAuthonzed Agent Date � <br /> Z <br /> �'� ��.'/�tC�s 7�%�rS� <br /> .�II��`"����""" ��. _ - - <br /> _ <br />