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IPE�CMIT APPLICATIOIv � <br /> CITY OF EVERETT PERMIT SER`✓ICES <br /> 3200 CEDAR STRcET, EVERETT, WA 98201 <br /> I 3� 425-257-8810- FAX 425-257-8857-www.everetivva.org � \� � i �D7 <br /> G�- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE N T ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P RM��IT� g <br /> 3x ko r�r� Avr� Qo s ooa Qo� � ��-tb�' -�''/ <br /> LEGA LOTNO. BLOCK TRACT a SP �O� <br /> DESC. ' - <br /> OWNER AUORESS CITY2IP • PHONE �Z� <br /> �R� Han�� �s -�� ia�iys�T�Av� ���,�,�Rys���6 s���a 3vs-a��� <br /> TENANT NAAIE � � I CONTACT FOR PERMIT P ONE <br /> � ���y � �f: �� �v2s)3v�s-a�3 <br /> , CONTRACTOR � ��, OM C.S� -�-�2 ADO ESS Clll'lZIP PHONE l�/7!S) <br /> r ia���-s7onrAv�:n�.��/'�1kRy///sviu-��4&a7a 3Y5-Q�63 <br /> CONTR.LICENSE# /0 �� u_O� � / ^�/�\ <br /> �I� I1 o77rna o y�os�os / ; �"; <br /> USE OF BUILDING HEAT SOURCE �� -CONTRACT PRICE OF WORK <br /> R�S��j���� _Electric �Gas__Other I �� 7 QQ� <br /> WORK DESCRIP710N . <br /> ��c�c� / � l ��-�v <br /> `��� ��.�e `�`�� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE GF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ¢_ Toilet A/C-air handling units <br /> � Bathtuo � Forced air systems <br /> � Lav�:��ry(wa�t,basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink S dispos2l � Gas Ereplac� <br /> Dishwasher Gasrange <br /> Ctothes washer = Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/badmop,'etc.) � Eshaust fan , <br /> _ Backflow preventer Heat pum� <br /> _ Urinal Unit heater <br /> Drinking Fow�;ain 9oiler <br /> _ Floor drain Refrigeration <br /> — Grease trap ^ I — Woodstove <br /> Rao(drains Other <br /> Other <br />� I �� v' CIIY OF EVERETT LOCAL SAI ES TAX COOE IS 3105 <br /> I herecy ceritify tha[I h;��e read and examined this application and know the sa�ae to be true and correct. All provisions of laws and <br /> ordinaces goverr,i;o this h,�re of work wi!I be complied with whether specified herein or not.The granting of a permit does not presume <br /> !u y�ive�uthority ro v�olat. ,:r cancel the provision of any other stete or local law regulating construction or the performance of <br /> c�nstruction. That I am auth�:�ted by the owner of this property to perform the work for which application is made and I comply with the � <br /> �tate •.^. rectors L w 18n.27 R�W and 296.200 WAC. � <br /> •�-�( , (-�vCGLLG��— <br /> S;g u:/ GvmenContrsctor/Au;honzed Aycnt Cate � L <br /> G <br />� U <br />