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, ._ <br /> r — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810— FAX 425-257-d857—www.everettwa.org 3 _a3-�l <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �Ja Q�j -O 3(� <br /> SITE ADDRESS PARCEL TAl(i.D.# PERMIT# <br /> 4� �''�'/k� S� �-lOf 13 -UVS <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> OESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENAN7NAME CONTACTFORPERMIT PHONE a(XO" 719'-D33�1 <br /> JPV�o lN�l� I��UN-Yl� �'/� IH �GL(1J�{Il'� E-MAILGIµ�LNC� UQ�'OIl�1GCc55�%L' • <br /> e�d- Censf7u � ccr� <br /> �a.vx, c�{`'v"`�,-�-o �.(.¢J , ri7 �' UU/ as3-79� -3�fs7 <br /> CONTR.LICENSE p 35'�av rYl r/��n-l��C 5, s9u-6�- i�� jg <br /> Dlfi-ry1oCS 9�1���7-��2 �11T�19 <br /> USE OF BUILDING I HE/�T SOURCE I CONTRACT PRICE pF WORK <br /> ys-,,,,, I� _Electric ._ Gas_Other �/Q �QQ. � <br /> Icl�'I"�� � <br /> WORKOESCRIPTION ���C,G-�IY'��LD.I'�Q, �L�S.f.� C�.�{.j,�iS�S,�yrU(S� �t�c� `I0 <br /> P�v.�urc, ad�-�(' �Ju�� a1-lered �v��+en'or' v <br /> l) <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF Fl%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling uni�s <br /> 8athtub _ Forced air systems <br /> Lavatory(wash basin) ____ Gas piping <br /> � Shower ____ Water healer <br /> Kilchon sink 8 disposal __ Gas lireplace <br /> Dishwasher _ Gas range <br /> Clothes washer ___ Clothes dryer <br /> �� Water heater _ Range hood <br /> Sink(service/badrnop'etc.) ____ Exhaust fan <br /> Backflow prevenler ___ Heat pump <br /> � Urinal __ Unit heater <br /> Drinking Founiain 9oiler <br /> - Floordrain _ Refrigeration <br /> � � Grease uap _ Woodstove <br /> --- <br /> Root drains _ O�her___ _ <br /> Other--____ __.. . __ _ -- — -- -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know�he same to be irue and correct. All provisions of laws and <br /> ordinaces governinq this type ol work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authority to violate or cancel the•�mvision of any other state or local law regulaling construction or the pedormance of <br /> construction.That I am authorized by the owner of this property ro pertonn tiie work for which application is made and I comply with Ihe <br /> StateGonirac�ors Law 18.27 RCW and 296.200 W/:C. <br /> ! / y <br /> � ��/�I�t i �z�r--/ .t.�/ili.1—.�T � 1 - y —��/ <br /> a�ur o wn r/ on� /Aut onze Agent ` Date � <br /> Z <br />