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i - <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES a _a3-ob <br /> 3200 CEDA.R STREET, EVERETT, WR 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org g p 60�.—OO( <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P��T� r, � <br /> � Zgo oZse o ooTpo � .��C, ���) <br /> IEGAL LOTNO. BLOCK TRAC7 <br /> DESC. S A S ��' <br /> OWNER ADDRESS CINZP PHONE <br /> O�LS N�I�ST' L�-G QI� II�l�1 AVE SE ���� PHONE��•�-I•Z7Zr� <br /> TENANT NAME CONTACT FOR PERMIT <br /> F�vlo�v�i/Ac��' I�¢OLQ �r5� 'tAfi'�Tis'�Z! <br /> CONTRACTOR ADDRESS CITYIDP PHONE <br /> t,�p'i <br /> CONTR.LICENSE X <br /> USE OF BUILDING �p�� HEAT SOURCE CONTRACT PRICE OF WORK <br /> WIPN�T'flC-1��1�'1` � ��G� I _Eledric �"�ias_,Other .�) ��/���/ — <br /> WORKDESCRIP710N ��is��� �-�.�� cs� �E7c"IST��-1 <br /> c, t�r �t-o �'�*�q�*' <br /> h1�A�-F �F C�I�R--� , t�W ��Ic.� S1�H� , l�l,�n lSl�fc_ W fW— <br /> ���0 f`�EW '►�ilS� �� l7dp(L lt�! t�*�M(�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> 7 Toilet _ A/C-airhandlingunits <br /> Bathtub Forced air systems <br /> � Lavatory(vrash basin) � Gas piping <br /> � Shower � Water heater <br /> Kitchen sink&dispos�i '� Gas fireplace <br /> Dishwasher _`Gas range <br /> Clothes washer _ Clo hes dryer <br /> Laun�y tray _ Ran�e hood <br /> 3L Sink(sarvice/barlmopletc.) _, Exhau34Qan <br /> Backflow p�evenler _ Heat pum� <br /> � Unnal � _ Unit heater � <br /> Drmking Fountaiq Boiler <br /> � Floor drain _ Refigeralion <br /> Grease lrep _ Woodslove <br /> Roof drains _ Other <br /> = Other —�I _ <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> i hereby centify that I have read and examined this application and know the same to be We and correct. All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied with whether specified herein or not.The granting of a pertnil does nol presume <br /> to gi��e authonty to violate or cancel the provision of any other state or Iocai law regulating construction or the performance of <br /> constr�ction.Thal I am authorized by the owner ot lhis property to perform lhe work(or which application is made and I comply with the <br /> State o actors Law 18 7 R�M�en�0 WAC. <br /> � !i///�� <br /> n ure o .vner/ ontra d u honzed A en a e ��� <br />