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i � <br /> I PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAP. STREET, EVERETT, WA 98201 <br /> 425-257-8810-�AX 425-257-8857-www.everettwa.org <br /> A�PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /p�a�7 "/C� <br /> SITE ADDRE55 PARCEL TAX I.D.!F PERMIT# <br /> I13.�.)_ ' "" �•.�c SE. � ll s� vl,�j <br /> LEGA LOT NO. BLOCK TRACT OR SUBOIVIS�ON• <br /> DESG. <br /> OWNER ADORESS CIlYILP PHONE <br /> I�v_��cr t 1�1Maicy MiLLL" �13 �-2 aLDAVES.E. �vFe�T� `��20c� `/d5'.)ti4 'I170 <br /> TENANT NAME � CONTACT FOR PERMIT PHONE 3g j-361 'G 3SZ- <br /> bfwLEtiO�+�,Y4MCR��'[•uCT <br /> �4uc_t: rPJ.rucy l��xL�E� (jczi,.cF �"���F� E.MN� <br /> P"5�"r S�uUt7 C-n� a 55 CITr7�—P <br /> �oi�ox 1985 S,u�ncn�=st� 98141 y;S-377-aEfsb <br /> CON7Ft.UCENSE# <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF W9RK <br /> � ' K. Electric _Gas_Other S��!-• �r , ��(,�O��J,G�C� <br /> �..ti�,�ii E �' %r�^•t t`l <br /> 'NORK DESCRIPTICN Co��: eT - r«P un r c - h�vT l✓ti�-C�� 3 Tcuf �- rTkF p"^c r F,e�n � <br /> (-<_[� 7v7 c %� Gns. <br /> 'L'JMEIMG NE�a.iNIC�L <br /> AO. "PE :F=1XTURE JR 1 icN 90 � �!PE•JF=7XTURE JR 1TEM <br /> I ' <br /> Toilet A1C-air handling units <br /> Bathluh �_ ;orced air systems <br /> Lavatoiy(wash basm) Gas piping <br /> Shower � Vlater heater <br /> Kdchen sinK 8 disposal K 3as fireplace <br /> Dishwasher �_ Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelhadmopletc.) Exhaust fan <br /> BackFlow preventer Heat pump <br /> Unnal UNt heater <br /> Drmking Fauntam Boiler <br /> Floor dram Refngeration <br /> Grease trap Wuadstove <br /> Roof drains Other <br /> Other <br /> CI7Y OF EVERETT LOCAL SALES 7A%CODE IS 3705 <br /> I hereby certdy Ihat I have read and examined this applicauon and know the same to be tme and cortect. All provisions of laws and <br /> ordinances govemmg lhis type of woik will be complied wlth whether specified herein or not.The gran6ng o(a pertnit does not presume <br /> ;o gwe auihonry ro violate or wncel the provisicr.����n;�mer stale or lopl law regulafing construction or(he performance of <br /> construction. That I am aulhonzed 6y the owner ot this property ro pertorm the work for which applicafion is made and I comply with the <br /> State Contractors Law td27 RCW and 296.200 WAC. <br /> I �__.—_ � �%��'f v 1���=-7/,�b <br /> Signature o(OwneqContraIXo�lAuthonzetl Agent pate <br /> � <br />