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-- ---- -------------- <br /> �— - --- <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT RERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g� �7 <br /> 425-257-8810— FAX 425-257-8857 —www.everetiwa.org <br /> APPUCA'i IONS ARE ACCEPTED FROM 8 AM TO 4 PM � /( �1-���`; <br /> SITE ADDRESS PARCFL TAX I.D.p PERMIT p <br /> 31s - E. cps �o v�n __ `,��' ' _ � ; <br /> LEGA LOT N0. BLOCK TRPCT OR SUBDIVISION M <br /> DESC. r�(_. . , i i i i �i�: <br /> OWNER / �';�ii�. / ( ' � � ADDRESS CITY2IP PMONE <br /> Po9>c 7szaY <br /> S�t.t�it��0 Ca�p D41ieT.�rx �,bse 1 11(�4()• L�Le <br /> TENANT NAME CONTACT FOR PERMIT J— PHONE �f).f�„39� <br /> 'Z— ll S�a��, laeae�o PN0.<6�t E•MAIL1f�iiPCTM[c�RP,c�.�.. <br /> 5�^'+C sol.�t�w�► ��.e- '�.�j01�+4J,rQc�!' <br /> CONTR.UCENSE N �����, wQ 'ZS}•3 7t„•�J'j 7. I <br /> S�+,ESv�yF43t��I i 48yna. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C o�+vlenence Sro�� —eie�i��c cas__oino� z SD D. D o <br /> WORK DESCRIPTION D ,���` Q�,STIhy CCJ PQ1C� Ce 1NL� <br /> e� 3 wt+�+ 4 r.rew o•�c. <br /> o'F ToN+e Slie. 4�.� wC�c�`Y <br /> PLUM8ING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> __ Toilet __ A�C-air handlinp uniis <br /> __ Bathtub __ Forced av systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> __ Kilchen sink&disposal _ Gas Ilieplace <br /> __ _ Dishwasher _ Gas range <br /> __ Clothes washer _ _ Clothes dryer <br /> __ � Water heater __ Hange hood <br /> _. Sink(servicebarrmop etc) __ _ Exhaust tan <br /> __ Backllow prcvenler ___ Heat pump <br /> Urinal Unil healer <br /> Drmking Fountain �oiler <br /> __ Floor drain __ Relrigerahon <br /> ___ Grease trap Woodstov <br /> __ Rooldrain; � Olher <br /> Olhcr —1��---� <br /> C11Y OF EYERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify Qial I have read and eaamined Ihis application and know Ihe same to be Irue and correct. All provisions ol laws and <br /> ordmaces governinq Ihis type uf woik will be complied wdh whether specified heiein or noL The granling ol a permit does not presume <br /> to give aulhority lo violate or cancel the provlsion ot any other s�ate or local law repulating consirurtion or�he pedormance ol <br /> consVuclion That I am aulhonzed bv t owner of this propc�ty to perlorm Ihe work foi which applica�ion is matle and I comply with ihe <br /> Sta�e Conlraclors Law iB 27 RCW 9620U WAC. <br /> f,J�„/ 7- ir� <br /> Signa�ure ol OwnmrCaitrac�aUAuthonzed Agent Date <br /> �(� <br /> i <br />