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� <br /> , — ---- — <br /> � P �RM���' A�'PL.I�;AT�I>tV <br /> CITY �F EVER�TT FERNifI SEF�VICES <br /> 3200 CEDAR STREET, EVERET?, Wr� S82U1 <br /> 425-257-8810— FtiX d25-257-8857—www.evereitwa.org <br /> APPLICATIONS ARE ACCE�fED FkOM 3 AIJI TO 4 PM - DEBIT & CFEDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � P9.RCEL TN:I.D.# PER IT# <br /> � <br /> ��� 3 3 7 ��z�c-r _ ����?"� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AL�DRESS CITYIZIP PHONE <br /> � t$3-3 j ' � _ �a 5 !2 S2` <br /> Le r.NN l,v ; NY�rc 1 � sr LVCKE`fT 32� 3 <br /> TENANTNAME CONTACTFORPERMIT PHONE , <br /> , ,1 �nw- �r�'ePFE(L C3ao� �{ ��f-'fo1`3 '7 � OFFic� <br /> �R' L� hN�.l Wiw.ieE2� l7'Q5 T�wF � �'AciFic Ce:iJ'S-'T'. '�'�Jt.�3G.e, (o(wl — ''fi 3 �- �!�� I <br /> CONTRACTOR'���LZ �q�� fc�C ADDRESS CITY2IP PHONE I <br /> Cm.�Sr. ZNc- 3�Z1��_�D'�c�gvR"� Ma-un�r VE2w+anl, �� 9d21j i <br /> CONTR.LICENSE# T�w�R <br /> �'c� � 14'3�3 �3c��) �ZY -!aF' 71 <br />� USE OF BUIL.DING — HEl1T SOURCE I CONTkACT PRICE OF WORK <br /> r-o <br /> .,— <br /> I -���., � L�� �L Electric �5G Gas Olher Gj � dOQ , <br /> � • C" L. C __ <br />;ree�.,._) i — <br />' VJORK DESCRIPTION � <br />.. '' �,��� i C-C�ir.+���. Tit_ �{�hwc'DEe_• fJf pN L�.�tiSTih�E`7?G�7'CqL Ct�iiJiC wt'TM <br /> � d�? - A 'Fc u RTF�f H Y C:c.,.� C- A.fLs=ra F�2 PA-ri�eN'rs - Uf',�'y��'k C�/o Y�c' <br /> . i I Q."V'Ji'ri�!J C- � � <br />' J3ac.�,tL J56o�+7 .'��,�a/ /SB�t�,/���-.�; , <br />�����`�.� PLUMBING E MECHANICAL <br />`�._, ,` <br />� '` � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �"t <br />,;'1``i�'�';'� Toilet _ A/C-air handling unils <br /> :�� ;;; BalhWb Forced air systems <br />�'�, r'� ; _ Lavatory(wash basin) _ Gas piping <br />��,�yrr� � �� S`�ower _ Waterheater <br /> r�,pi':`.:` I Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gas ranc�e <br /> I �_ "iothes washer Clolhes dryer <br /> L ndry fray _ anc�e hood <br /> � aL Sink� erviceioadmoplalc.) x 3usl fan <br /> Bacl:flc reventer Hea ump <br /> Urinai _ Unit he r <br /> Drinking Foun 'n _I Boiler <br /> Floor drain Refrige�ation <br /> _ Grease trap `� Wocc-lov�� <br /> Roor drains �� Olher_ ._ <br /> I = Olher — — — - <br /> �� CITY OF EVERETT LOCAL SAL'cS 7AX CODE IS 3105 _ <br /> I hereby ceritif;thal I have read and exa�nined lhis application and know lhe same tc be true and c xrecL All provisions of laws and <br /> ordinaces govemirg this type of work will be complied with whelher speci(ind herein cr noL The c�ranting of a permit does not pres�me <br /> to e�ive aulhonry co violate or cancel lhe provision of any other state or loc�l law regulaling construclion orlhe Fer(ormance of I <br /> conslruclion.That I am aulhorized by the uwner of this property to perform lhe work for which applicati<�is made and i:omply with lhe <br /> Stale Contrectors Law 18. 7 RCW and 296.200 AC. <br /> � �c�:erz ��:F�L <br /> t;u,�' � � <br /> r�, �.�_�. <•=aw�i. �n,c. S/Z 3(c+5 � <br /> Signature of Owner/Contractor/Authonzed Agent Dete �Z. <br />:�� — — — — I <br /> -- � ...�...�.. <br />