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� <br /> 3. <br /> PERMIT APi�LICATION <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE7, EVERE7T, WA 9820i <br /> 425-257-8810— FAX 425-257-SE57—�v�+nv.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T/J 4 PM - DEBIT 8 CREDIT CARDS.4RE NOT ACCEPTED <br /> SITE AD�RE55 /� PARCEL TAX�.D.# PERMIT� —7 <br /> 5 2 � Cv�,irtvr 1� c�as8 /9do oa Syoc� M �� -'� _ � / <br /> LEGAL LO7N0. BLOCK TRAGT <br /> DESC. <br /> OWNER �i1DDRESS CITYIZIP PHONE <br /> T N^� S �9 S SOfi Z y �O �v f/ fl Lt� .�F �7r.«i ZS� 9�o yo <br /> TENANT NAME ' CONTACT FOR PERM1IIT PHONE /' <br /> G�r��rty ��N 9��� /T�Y ry IN �yf'/ S 2Q�i. �63 ' �7T � y 2 6 <br /> CONTRACTOR � ADDRESS '�ZJ yH��/� CITY2IP PHONE 20` 76j, /7 y <br /> Evr,�cr.� �P��„�9�b.r ZNc .� ^'8io y <br /> �ycor S/. B <br /> CON7R.LICENSE# F�/L' G' � <br /> .� / 20PD7 <br /> USE Of BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �as_Olher � // 2 �� <br /> WORK DESCRIPTIO 1J� 14C �`,l � <br /> Un�-� c.�-,a��, awf � �i�.l�v�v� y bcvk��.. r� "�i � �s - <br /> _ �,�pi�.� ���,,n��s n�a� �q�-a ��,� t��. <br /> PLUMBING . MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEh1 <br /> Toilel A/C—airhandlin�units <br /> �alhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolh=_s tvasher Clolhes dryer <br /> Laundry tray _ Range hood . <br /> Sink(service/badmop/etcJ _ Exhausl fan <br /> _ BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Gma;e trap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> _I <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> I hereby cerilify Inat I have read and ezamined this application and know the same to be true and correct. All pmvisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting of a permil does not presume <br /> to give aulhority to violate or cancel the provision of any olher stale or local law regulating construction or the pedortnance o( <br /> construction.That I am authorized by lho owner of Ihis pwperty to perform Ihe work for which application is made and{comply with the <br /> Stale Contrac%% W a� �WAC. 2� / � <br /> � �O <br /> / <br /> Signal�ire of Ov;nedCo c dAAulhor¢ed Agent Date <br />