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PERtVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 S�--Q 6 <br />425-257-8870 — FAX 425-257-8857 — wuvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �Cl� <br />� <br />SITE ADDRESS <br />3ao Ta�Ma✓ac.l� AvF_ <br />LEGAL LOTNO. B��K <br />DESC. b t��p p. <br />OWNER <br />7.,se�, (Z �3er ere�—^— <br />TENANTNAME <br />CONTRIICTOR O � N E � <br />CONTR. LICENSE / <br />USE OF BUILDING <br />� �� <br />WORKDESCRIPTION N�w ho+�e. <br />Hp, I TYPE OF Fl%TURE OR ITEM <br />Toilet i � 1 I <br />Bathtub� %� <br />Lavatory (wash basin) I� i ��'� <br />Kdchen sink 8 dlsposal � <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbar/mopletc ) <br />BackAow preventer <br />Unnal <br />Dnnking Fountain <br />Floor dram <br />Grease trap <br />Roof drains <br />Olher <br />�PARCEL TAX ( D. N <br />Oo393yooc <br />�cr <br />Q2✓CP�9 N���S �i V <br />ADDRESS �-- <br />3ao-r'�,-.��r,..►� <br />CpNTACT FOR PERMT <br />����r� 6e� ��'��� <br />K�M Sr..nner <br />ADORESS <br />HEATSOURCE <br />�•✓c,,oti' °i <br />_ Eledric X Gas _ Other <br />CIN21P <br />�RMIT � � <br />Cc�b03--Z'�/� <br />PHONE ya5�S�4-S��4 <br />��3 4is-350-�`w� <br />PM°r�E yAs-35o•byol <br />ya5'- 3'�1-Set8 <br />PIIONE <br />CONTRACT PRIGE OF WORK <br />�� g �i -7 � "`i <br />Np, I TYPE OF Fl%TURE OR ITEM <br />c� <br />� <br />AIC — air handling unds <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood� <br />F�chausl tan I i 1 f � <br />Heat pump <br />U�it healer <br />Boiler <br />Refigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby ceritity that 1 have read and ezammed this application and know the same to be hue and correcl. NI provisions ot laws and <br />ordinaces goveming this rype o( work will be complied vnth whether spedfed herem or not. The grantirg of a permit does not presume <br />to give authonty to violate or rancel the provision of any other state or local law regulating construction or the performance of <br />construclion. That I am authoraed by the owner of thls property to peAortn the vrork for which applicatlon is made and I wmply with the <br />Sta Contre rs Law 1827 RCVY and 296 200 WAC. <br />� � � �aa-o� <br />Sig a ure of OwnedConh odAuthaized Agent a�e i! <br />(7i <br />,, .��1�-. Y3�� i�.� �___L,�•,.,�... <br />,, . <br />