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�--- <br /> � - - --� I <br /> PEFtIVIIT �►PPL�C�OTi I�?�I ' <br /> CITY OF �VERETT PERMIT S�RVICE� I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FFiX 425-257-8857 - www.everetlwa.org <br /> i <br /> APPLICATIONS ARE ACCEFTED FROM 8 AM TO 4 PM 3 _'a.}.r0 <br /> SITE ADDRESS PARCEL Th.X I.D.# �'ERMIT# <br /> �cbt 3�'TM` Av�. w. , �uEFZErr 280403oot oo2Do ` i73 � � S <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC.� <br /> OWNER ADDI;ESS CITYIZIP PHONE <br /> 11-t7�,z/i.tEG lvGb1 2�(0�' pNE. Y-!.� �VEfL-'T'� �82A3 425 • 2�b�• 2�4�3 <br /> TENANTNAME �� CONTACTFORPERMIT PHONE <br /> It�CfT'��SEG ���.14- �l �U ��� 'bCV«l SAYL�� �F25• 25�• �868 <br /> --�—- <br /> CONTRACTOR ADf!FF_SS CiTYIZIP PHONE <br /> at�G�(_l_ b co., itii�. "'l l� 123a:c AVE. �. LAKE S'sE.vEs�lS 425•�i�t- • If�B� I <br /> CONTR.LICENSE# °-�8ZS�7 ��, <br /> AtaGEI_G lC�1l�� <br /> USF OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK I <br /> o��tc� �x�cnot� � <br /> S"CL'f�PG�G _Electric �C Gas_Other �`��� ��' �� <br /> WORK (JESCRiP710N I <br /> �.�MP�L� '1�r.lA�-(t' IM�Fz�j.lEMC-t-t't' �-�S� F�-0SZ CO[�S�UG^C10t-1 � C17 t-(�V�! <br /> � Y�lAI.C. A6�lt� thl�3tALl.. .� GP�hlE?Z �KN(SHEt� �UtPt�etL-N"f. . <br /> PLi�MBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF Fli(TURE OR ITEM �i <br /> I _ __ Toilet _ A/C-air handling units ' <br /> Balhtub Forced air syslems <br /> Lavatory(wash hasin) _ Gas piping <br /> Sh�we�,� Waler healer <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dish:;a�' �� Gas range I <br /> !'e!: _ ..asher Clolhes drver ' <br /> �^.�a!��healer _ Ranc�e hood <br /> Sink(servicelbadmop/cic.) Exhaust fan � <br /> Back(low prevenler _ hleai pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> ; Floor drain _ Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVER[TT LOCAL SALLS TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis applicalion and know the same lo be lrue and correct. All provisions of laws and <br /> orJinaces c�oveminy this rype of work will be complied .vilh whether specified herein or not.The granting of a permit does not presume <br /> to yive au�hority to violale or cancel the provision of any other state or local la�v resulaling construction or ihe peAormance of <br /> construction. That I am authorized by the owner of Ihis properly to perform lhe work for which application is made and I comply wilh the � <br /> State Cor�tractors Law 1 7 RCW and 29 .200 WAC. <br /> - , <br /> . _ . ��� �G�� <br /> Signalure of 0 edContradmtkatifo ' ed r�.gent Dale �i , <br /> .;y I <br /> f <br /> - -- :.� - -� <br />