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Ql,g cv�a,�__��� — <br /> � �C�t^^�,�s� ' <br /> PER11IIiT APPLICATIO[� �, <br /> CITY OF EVERETT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—fAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(��- � 3`JX <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# . <br /> �oz � �P� . (� ��6� o o �o z� 000�2�0o h�c� ��c> -os5 <br /> LEGAL . LOTNO. BLOCK TRACT <br /> DFSC. <br /> OWNER A�DRESS CINIZIP PHONE <br /> C�-rbo-�'0. �M��-cl�� Z�,.� c� s s �� ��Zs-zs����66 <br /> TENANT NAMG � ( CONTACT FOR PERMIT PHONE <br /> � �.,� l:a�+-�-�r� �-�� � �C7 �11g '�Oo <br /> CONTRACTOR � r Y V.�'T ' %� ��'I � � �" � � .� <br /> ]`� l �C�� I C ����` ADDRE89���; -�t�� _�CITY P PHONE �� <br /> �.�� �Vi_ H � � �[ a �" - _ <br /> �i�'u�J fz��-5 �y'/��ir,rr'�L7 <br /> CONTR.�ENSE# � ,�I 5� Y�7SJ ��, � <br /> (_UA5/�Tl�`%5���'� `%��"� 3�' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> i <br /> �'����� _Electric �as_Other 3 �� � ; <br /> WORK DESCRIPTION '. <br /> Ct,�a�.� �.�..�— �'l� -�ct5 c.�c-�C,r I�e.�ri , <br /> I <br /> PLUMBING MECHANICAL �� <br /> NO. TYPE OP F�XTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> Toilet A/C-air�.iandling units � <br /> BalhWb _ Forced air systems I <br /> Lavalory�v�ash basin) Gas piping <br /> _ Shower � Water haater �II <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer 'i <br /> _ Laundry tray _ Range hood i <br /> Sink(service/badmop/etr,.) ,_ Exhaust fan <br /> Backflow oreventer _ Heat pump i <br /> Unnal Unit heater <br /> Drinking Fountain _ Ooiler <br /> Floor drein Refrigeralion <br /> Grease trap Wcwdstove <br /> Roof drains Other ; <br /> _ Olher -- — — I <br /> I <br /> — CITY OF EVERETT LpCAL S/SLES TAX CODE IS 1105 i <br /> I hereby ceritify Ihat I have read and ezamined ihis application and know the same lo be lrue and cortect. All provisions ot laws and I <br /> ordinaces goveming this type of work will be complied vnth whetfier specified herein or noL The granting of a permit dces not presume <br /> to give authority lo violate or cancel the provision of any olher slale cr local Iaw regulating construction or the performance of II <br /> construction. Tha�I am authorized by Ihe owner of ihis proparty to perform ihe vrork for which appliration is made and I comply with the <br /> State Cornrzctors Law 1827 RCW and 296.200 WAC. I <br /> �� � o- i <br /> ISignature o Owner/C ntractoi Authonzed Agent Date � I <br />