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( <br /> PERMIT APPLICATION <br /> ( CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � Z—/�(—O� <br /> SITE ADDRESS PARCEL TA%I.D.# PERMIT�f <br /> /3�� c� ��E3S 3� 9 y�� -0�° <br /> LEGA LOT NO. BLOCK TRACi OR SUBOIVISION� <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Tuur //11.<NLSTHnJ 13�k Puc�cc+r /-?v� �Ni 982U1 y�i- 25Z-83a7 <br /> TENANT NAME CONTACT FOH PERMIT PHONE <br /> I g2'!� �CuFF �/u��'7S-6y6S� <br /> CONTRACTOR ADORESS CITY/ZIP PHONE <br /> D�+l e-��r� P�.,.,QU- a-NrtT IGG�y �3� Ave Iv N'�^' y2s-�7,s � �/��i <br /> CONTR.LICENSE p L��d'7 <br /> DA✓Ny►�H 9yU�Q <br /> USE OF BUILOING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas_Other � �3✓!•SU <br /> WORK DESCRIPTION <br /> �EP�RcE E.x�sn��-' �ri45 �r�r�z+vA-C� WiTFf <br /> N� Grrs ,�i�e.�acE T,� s,a-�� �ocfrn�. <br /> ( NC> N s �P,� <br /> PLUMBING MECHANICAL <br /> NO. TYPEOFFIXTUREORITEM NO. TYPEOFFIXTUREORITEM <br /> Toilel A/C—air handling uni�s <br /> BathNb ]_ Forcod air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterhealer <br /> Kilchen sink 8 disposal __ Gas fireplace <br /> � Dishwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Walcr heater _ Ranc�e hood <br /> Sink(service�badmop/elc.) .__ Exhausl fan <br /> Backllow prevenler ._ Heat pump <br /> Urinal ____ Unii heater <br /> _____ Drinking Fountain _ Boiler <br /> Floor drain ._ Relrigerahon <br /> Grease Irap _ Woodstove <br /> Rool drains _ Other <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> I hereby ceritify that I have read and esamined this application and krow Ihe same to be lme and correcL All provisions of laws and <br /> ordinaces governing this type ol work will be comolied wilh whether specilied hemin or noL The granting ol a permit does not presume <br /> Io give authoriry�o violale or cancel Ihe provision ol any olher slate or local law regulating construc�ion or the pedormance ol <br /> conslmclion.That i am aulhoiized by Ihe owner ol this properry to perbrm�he work lor which application is made and I comply with ihe <br /> Sta�e Conira tors Law 1827 W a/iy7d�29 f,��Q�0 WAC. <br /> �Y}GIvL�%�C�isz��/�+— ��7,'7/� <br /> Sgnalure ol QtvncrlContractodAul ¢ Agenl � �a� <br />