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�_ - <br /> PERM�T APPLICAI iON <br /> CITY OF EVERETT 'PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-SE357 -www.evere:twa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT I <br /> 331 � I��o��c� �v� on4 � 7s7�oc� goo C!�<�� �'Cjlj� <br /> LEGAL 1.0T NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. 2,% � � 7 � 4 D 1 V t'V <br /> OWNER ADDRESS CIN2IP PHONE ,�,'Z j_ <br /> ��_v �c7 . 'i �,-c,�.�¢ � . 1 ��� � 1 � 33�� L'rc,...�: A.�c Lti:_r� i-� ,lJA �32u1 3U3963q I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 4z �-303 - 9�? 9- <br /> �rL.vi .I I�_rI'� � I E-MAIL <br /> CONTRACTOR ADDRESS � CITYIZI PHONE <br /> IZ��,�y �11 �5 292iJ 12Is+ �v.>i: L��.-._ii,i.7,a %52::� AZ�- z33 - 98L � <br /> CONTR.LICENSE t! `L LZ 5 R C O 4d J i..: <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> -� 1 2- t3 , G c'i� <br /> ��� �>�c� c n c:�. .�Electric _Gas_Other � <br /> WORK DESCRIPTION I I <br /> NC� '� r.�.c��: ��...�' 1?�:a�Tc� SU ��C � <br /> ��� <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> - I <br /> � v Toilel _ A/C-airhandlinyunils �I <br /> � Balhtub _ Forced air systems . <br /> L_ Lavalory(wash basin) Gas piping <br /> Shower �= Water healer � <br /> _ Kitchr.n sink&disposal Gas rlanPeCe '�I <br /> Dishwasher 9 <br /> L Clolhes washur = Cblhes dryer � <br /> Walen c�aler Range houd <br /> Sink(service/6ar/mop/etc.) C. ,/ Exhausl fan <br /> 6ackllow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Foun�ain Boiler I <br /> Floor drain _ Re(rigeration <br /> Grease lrap _ Woodstove li <br /> Roof drams _ Olher_ <br /> Olher _ — , <br /> CITY OF EVERETT LOCAL SALES TIU(CODE IS 9105 <br /> II hereby ceritify thal I have re2d and examined this application and know lhe same to be true anA correcL All pwvisions o(laws and <br /> ordinaces governing this type of work will be c:omplied with whelher specified herein or not.The granling of a permit does not preswne <br /> Iv give aulhority lo violate or canr.el the provision of any olher slale or Iocal law regulaling conslruction or lhe perionnance of II <br /> construclion. That I am aulhorized by lhe o�vner o(this property lo pcAorm the work(or which application is made and I comply wilh ihe <br /> � Slale Con(ractors Law 182 CW and 296.200 WAC. <br /> �� ��.,���� 7�2i�UH � <br /> I, SignaWre o(OwnedContraclorlAulhonzed AgeN ua�e �� I <br /> Z I <br /> � - _ — -- - <br />