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i +, <br /> PERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT, WA 9820'I -O�! <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org �j <br /> APPLJCATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.k PERMITfI <br /> i�_�;�,-� s-I-• �� �- ' �i82oI Uc5 � 3 02 C 7U � <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. n �r so� ' 2 13 p � �l`� d 'i c� <br /> OWNER ADDRESS CITY2IP PMONE �C„ <br /> r * <br /> ��t,�, r�l�,��,•�, � Ca�t,�� ��l.s ��LI �� ��„•zt-� �-�. t�lzre-tl-, C��r 1r+z.b� �, � <br /> TENANT NAME �/� CONTACT FOR PERMIT �� FnF{c.{-��°�F'I�� PHONE i'LS�{(�2 Yc2HU <br /> _ ��f l � �tiC���C� �1,� ( 'CPU J �O"M�. �9'�4i <br /> CONTRACTOR �� `� �1� ADDRESS CITY/ZIP PHONE <br /> I�iVtt�lil;� SerU icCs �(.� (�,cr� z6R5 4L5- Y6z - <br /> CONTR.LICEIISEft �V �z�a <br /> 61�COi�1ST.�112 P�C. �1u1'�pnc1 ��- ��07�3 � <br /> USE OF BUILDIN6 HEAT SOURCE CONTRACT PRICE OF WORK j <br /> r�Q.s� C . _e�ecn;c ,�cas_ah�� � g r'�p'; n� <br /> WORI(DESCRIPTION �pN�jY. ir� For 1C:bt,l�cn S ;.IL , �v-� i�,.n T_�� Ml�1<L.^. P��•Mh�^� <br /> ���il �t:� Pcr FLc.L F:v;., �,.,b MC.Tcr �o �+o.,tiN. , c.a� P �,,.� �.� �::� �+la�� 9 �'L; <br /> �Lq � ��;.�-. 1P�hS<�� ccc-Wc.� a.,::r � K t41-a.� � �<S�c.- 3��c�o�_ Ci:�:.f� 4. Of�F:�c. �e:t,-`1 <br /> � - ., • (1-�S :.-. ' �,,,�� 1C:f . ' '41\ •3- 'a.r. t�c.�ti c^ 3l. G <br /> PLUMBING MECHANICAL ��� <br /> NO. TVPE OF FI)(TURE OR ITEM HO. TYPE OF FI%TURE OR REM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) �{_ Gas pping <br /> Shpwe� Water heater <br /> � Kitchen sink 8 tlisposal _� Gas fireplace <br /> ,�_ Oishwasher �(_ Gas range <br /> _ Ctolhes washer Clothes dryer <br /> _ Laundry Vay Range bood <br /> Sink(service/baUmop/etc.) Exhausl fan <br /> _ 6ackP,ow preventer Hnat pump <br /> Urinal Uni;heater <br /> Orinking FounWin Boiler <br /> _ Floordrain liefrigeration <br /> Grease trap Woo�stove <br /> Roof drams Olher_ <br /> _� OlhCf Lj�_ c�c.lCtr —Rf.�r�7�+�}V�' — <br /> � CITV OP EVERETT LOCAL SALES TAX CODE IS 7105 <br /> � I heceby ce�itify ihat I have read and er.amined this appfication and know the same to 6e hue and mrrect. All provisions of laws and <br /> ordinaces governing this Npe of�vork will he complied with whether specifetl herein cr nct.The granting oF a permit does not presume <br /> I to give authonry to violate or cancel the provison of any ottm.r state or local law regulatinQ conshuction or Ihe peRormance W � <br /> conslruction. That�am authorizetl by the owner ol Ihis Aropeny to periortn the work tor N�hich application is made and I comply with the i <br /> State Conlractors Law 1fl.27 RCW and 296.200 WAC. <br /> \.�14'�J �,�.� . IS �r... 7c2��OC.�I Z." z. ' O� <br /> �gnaWre of Uvncr!(,onfractor/Authonzetl Agent — — Uale—�- — — — — — — I <br /> J <br /> Zd 8VE8 i,9V (9Zb) �JNIl�Vil1NOOH9 dl4'Zl LO ZO 4e� <br />