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i - -- -- - - -, <br /> �— PERMIT APF'LICATION !�, <br /> C17Y OF EVERETT PERMIT SERVICES i <br /> ' � 3200 CEDAR STREET, EVERETT, WA 98201 �I <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ', <br /> ' �' Cr// - n/G� <br /> �, � ,`, ^ :-� � � APPLICATIONS ARE ACCEPTED FROM 'd AM TO d PM �(/"' � <br /> I� SITE ADDRESS PARCEL TAX I.D.# PERMIT# v:°� � <br /> �� '' 'f � - � , 3 , ?°04,OZoo3oo60� � � ��% - �`�'�� i <br /> LE�AL LOTNO. BLOCK TRACT j <br /> DESC. �p� CL K � j���A�+nQf1 .CdM li <br /> OWNER ADDRESS �q CI 21P PHONE �3 �� I�IO '�. <br /> I -ToG Ma�.�Ar�t�r , �v�cGs �gzs�:�fi. �T'c�� c�.9�u.3 I <br /> TENANT NAME CO TACT FOR PERMIT PHONE <br /> Tc� M �vs ��a�u ka�p a���:�.p�?r�s � �O�-`��'?• <br /> CONTRACTOR ADDRESS c '� CINI��PHO� �� � I�I <br /> I�I CONTR LICENSE# � <br /> �'Y7' '"T I <br /> � Gk�INt�LGLLnO� �, ��e��'��� V�fk Cf4�W5 <br /> USE OF BUILDING —� HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (�.F(C� _Electrir, �Gas_Olher � -J�- 4,r ��� <br /> I � y <br /> I WORK DESCr:iPTION <br /> '� F--l� TV-�U Sf7�� o�l�� �Jl(�l�C�' � `k�°I��1�G' � <br /> ' PLUMBING MECHANICAL I <br /> i,l <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ A/C–air handling units <br /> Balhtub Forced air systems , <br /> � Lavatory(wash basin) _ Gas piping <br /> I � Shower _ Water heater <br /> � Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood � <br /> � I� 1� Sink (service/badmop/etc.) _ Exhaust fan � <br /> Backflow preventer _ Heat pump II <br /> � Urinal _ Unit heater <br /> i � Drinking Fountain _ Boiler <br /> Floor di ain Refrigeration <br /> Grease trap _ Woodstove � <br /> Roo(drains Other <br /> ��i Other _ ��i <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby csritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume �i <br /> to give authority to violate or cancel the provision of any olher state or local law regulating conslruction or the performance of <br /> construction. That i am a�thorized by the owner of this property to perform the work for which application is made and I comply with lhe I <br /> j State Contract rs Law 1827 RCW and 296.200 WAC. <br /> I �,l..eX�Y � II <br /> Si na ure o Owne /j', ntractor/Authorized Agent Dat �/ <br /> � L <br />