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, <br /> PERMIT APPLICATIUN <br /> CITY OF 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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ER IT# <br /> �g ��ak v�� u4��- eo 6o�3odao iqoo c�—Ot <br /> LEGAL LOT NO. BLOCK TRAaCT OR SUpBDIVfIS,ION# �/ <br /> DESC. OOO 1���'�JI�evY� �V �S�L�/� �� <br /> OWNER ADDRESS CINIZIP PHONE �_ <br /> �VltcN�}E� P►4Blsz ayz$ ��4R►c �'Ic�' 1.fl�J� EV��Yr�7 48�3 3y7-848z <br /> TENANT NAME CONTACT FOR PERMIT PHONE - � `2�IG�$� <br /> �',��$ �CLI-l'�� E-MAIL 4eur�J¢,s�ir.r�:�i(imfllt <br /> CONTRACTOR A�DRESS CITYIZ P PNONE � �I'�1 <br /> �t�-Lr`Rranl Co,JS'r, /nc 14oh ygT�lss� � �I�`TT 9�4iz�3 '�u-31b-z�as" <br /> CONTR.LICENSE f�� ` . • <br /> C� c ����-Say9lnr <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,Sl�ylc Ft)�n�� ' f��ID�1LF I _Eleclric �Gas_Olher I ��d` OD� . � <br /> WORKDESCRIPTION /�DDI7�O�I �� Cr.61$riJC� �Iomt - N� <br /> SU�/2oom � Rc� Rao��1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl AiC-air handling unils <br /> g������� Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W a�er heatcr <br /> ilche sink& disposal _ Gas(ireplace <br /> ish �sher Gas range <br /> Ciol es washer Clolhes dryer <br /> W ten c�ater Range hood <br /> = SinF (servicelbarhnop/elc.) — Exhausl(an <br /> B�ck b�v preventer Heat pump <br /> � Urina\ = Unit hcater <br /> — �Drinkir�j Fountain Boiler <br /> Ploor drain Re(rigeralion <br /> _ Grease trap Woodslove <br /> _ Roo(drains � Olher �:_-� /'C-«15 <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceriti(y Ihat I have read and examined lhis application and know the same lo�e Irue and correcl All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whelher speci(ied hmein or not.The granting of a permit does not presume <br /> to give aulhorily to vi�ilale or cancel�he provision of any olher stale or local law regulating conslruction or the pedormance of <br /> conslruction.That I.�m aulhorized by lhe owner of this proporty lo perform Ihe work for which application is made and I comply with the <br /> Slale onlraclor L-a�v 1 .27 RCW and 296.200 WAC. <br /> �� �el��- (D- a9-o9 <br /> Signature of OwnedContraclor/Aulhorized Ac�enl Dale / <br /> — - � �� <br />