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� ���� � ,��� <br /> � �°�=---- ---- ------- <br /> � PERMIT APPLI�ATION �O `a3-�g <br /> CITY OF EVERETT PERMIT SERVICCS � � ��.� �' I�� <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org C�L'; > _� `a0� <br /> _ ................ <br /> APPLI TIO ARE ACCEPTED FROM 8 AM TO 4 PM GTY """'•� ••..., <br /> SITE ADDR[SS �� PARCEL TAX I.D.# "�aM✓�'l4blic SerW�a <br /> ZJ�D!/ 2u.c�C,¢.rt- � (�JO`�3q � SS 9 0 3006 � `.��,�o � �& <br /> L[GqL LOTNO. BLOCK TRACT <br /> DflSC. <br /> OWNER ADORE55 CITYIZIP PHONE <br /> 5�.�.�,. K�.-,� �� c�Z� 3�-;-,s� <br /> TENANT NAME , � CONTACT FOR PF.R!n1T PHONE <br /> �nrt.�� -�-w�� ' Z g-(�Y3Z �'- ar'v..�,.... W..elo5�2c�- �G�s?l&-4Sg`6 <br /> CONTRAC R �% ADDRESS �� i'-� /� �CITYIZIP PHONE -� — <br /> ��J�sN������-r<,� l��-rr� �,s�; , i r� ���� <br /> ¢L�« /r� ..-•> �yr:lx�.,� /� 5 -y73�' <br /> CONTR.LI ENSE 11 � �� <br /> C�i�S��rlx�`�5��� ��, �j��3�3Y <br /> USE OF BUILDING // I NEAT SOURCE CONTRACT PRICE OF WORK <br /> — �S�J,n.L� . - �I rJ�,, ✓Eleclric _Gas_Other J /�� <br /> (.l+ T( <br /> WORN DESCRIPTION /�� / " � '"�" - / <br /> a�an�e- � C� � �2ct�/'rC (,c�� �"-f C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ AIC—air handGng units <br /> Bathlub _ Forced atr systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Laundry Iray _ Range hood <br /> Sink(service/bar/mopletc) ._ Exhausl fan <br /> Backflow prevenler _ Heat pump � <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Doiler <br /> Ploordrain _ Refrigeration <br /> Grease irap __ Woodstove <br /> Roof dral s v,� �_r - „ _ Other _ <br /> � Olher "�te-��-- — — <br /> QTY OF EVERETT LOCAL SALES fAX CODE IS J105 <br /> I hereby centify lhal I have read and examined this application and know the same to be Irue and correct. All provisions of laws and <br /> ordinaces governmg ihis type of work will be complied with whether specifed herein ur noL The granting oF a permd does nol presume <br /> to give aulhority to violate or cancei the provision of any other state or 1oc31 law regulating construction or the performance of <br /> consWction. That I am authorized by Ihe uwner of this property to perlorm the work for which applicalion is made and I comply w9h ihe <br /> 5 ate Contradors Law 1827 RCW and 296200 WAC <br /> �-�,.,�1,.�,,� �1.�,�o S�eer— \o -z�-0 'b <br /> SignaWre o�f OvmedContrador/Authonzed Agent Date " <br />