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� <br /> PERMIT APPLICATION <br /> CITY OF EVE:RETT PERMIT SERVICES <br /> 3200 CEDAF:STREET, EVERETT, WA 98201 <br /> 425-257-8810-F4X 425-257-8857-w w.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �I.C� (p L�c1 ' �� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> , oo39a4o ,00,00 , l' �o�- /�, <br /> o .TG 17 • JERE-" )A o 0 3 9 a9 o i oo i o00 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �� /O I 3EJEk1-Y f�wS L�J 3 <br /> OWNER ADDRESS CIT1'21P PHONE <br /> 360-G$� "OY/3 <br /> KA� 8,evu�^J 56 ao /co'_y PL Al •�• /''l�4Qys�zF.uE ,.JA y,��o <br /> TENANT NAME � CONTACT FOR PERMIT PHO�E <br /> I-i'�M e�lrco� 3�0- a�� -Ss� <br /> CONTRACTOR ADDRESS CITY2IP PHONE 3(pp•d.�/' <br /> /�.rfi�./� �c�rt�'i dv3-�sF�oo�. a�� . ��sboulA� es�o <br /> CONTR.LiCENSE N 483� <br /> +-t�cH�.p=98zc� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �������L �p�� �lectric _ _Gas_O�her �y0 ��O . " <br /> WORK DESCRIPTION �.�9 3 r g o� �-��j� <br /> C4�. <br /> � � � 5 0 7— y�•�' �>�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling unils <br /> d Balhlub Forced air syslems <br /> d lavalory(wash basin) Gas piping <br /> � Shower � Waler heater <br /> d Kitchen sink 8 disposal _ Gas fireplace <br /> d Dishwasher Gasrange <br /> �2 Clolhes washer _2 Cbthes dryer <br /> Laundry tray � Range hood <br /> Sink(service/bar/moplelc.) � Exhaust fa�� <br /> Backflow preventer Heet pump <br /> Urinal �_ Unil heater <br /> Drinking Fou�lain _ Boilar <br /> Floor drain Reirigeration <br /> Grease lrap _ Woudstove <br /> = Roof drains I = Other <br /> Olher <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 5105 <br /> I hereby cerilify lhat I have read and examined Ihis application and know the same to be true and correct. All provisions o(laws and <br /> orAinaces goveming lhis rype of work will be complied wilh whether specified herein or nol The grenling oi a pertnit does^ot presume <br /> to give authcri�y�o violate or cancel Ihe provision of any other s�ale or Iocai law regulating construction or Ihe pedoimance of <br /> consiruction.Thal I am aulhorized by lhe owner of this property to perfortn ihe work for which application is mado and I comply wilh lhe <br /> Stale Coniracl�Law 1827 RCW and 96200 <br /> � �/� � 8�is�o� � �z <br /> Signature�bwnedContrac or/Authorized A ent Date y <br /> � vLZ�'� <br />