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^— <br />� �- PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-Bfi10— FAX 425-257-8857 —w�w.evereVV�OVVpRrg <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (,� ../ 3—O 9 <br /> SITE ADDRESS PARCEL TAX I.D.91 PERMIT# <br /> fD217 �`�� A�,E 5tE S�:�e �o� dlo ao�0002a 1�� Sc90'-�-00� <br /> LEGAL LOTNO. oLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> �uYl f-c��si �����« 123� ���lu�s� Cu�r� 9 �a�;-s6o� <br /> TENAr T NAME I CONTACT FOR PERMIT PHONE <br /> C �lCls,� � (�i��� Ly�.c � 3Go-�/z�(-� 3zr <br /> CUNTRACTOR`RAeY-C.J—S�' ��- �uJ.Li�F���DDRESS CITY121P PHONE <br /> `� 5 �?1x�8 NWY4`tsu�fi'� 3(,c,-Y2y-�32S- <br /> CONTR.LICENSE# �.e.�.«5�03�� I^/I UU�1.TU.(JUp� �n/(t �gZ7� <br /> USE OF 6UILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Ljtv�, K _Electric _Gas_Other �j��o^ <br /> WORK DESCRIPTION <br /> (Ze(�I�a.ce � �-�'� S�S�S <br /> PLUMBING MECHAN!CAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> ToiOt A/C—air han(�ing units <br /> —athtub _ Fcrced air systems <br /> i avatory(wash basin) _ Gas piping <br /> Shower _ t aterheater <br /> � hitchen sink C disposal _ Gas fireplace <br /> aishwasher Gas range <br /> Clothes washer Clothes dryer <br /> i aundry tray _ �ange hood <br /> � Sink(service/barlmopleic.) _ Exhaust fan <br /> —ack0ow preventer _ eeat pump <br /> r rinal _ � nit heater <br /> arinking Fountain _ —oiler <br /> Floordrain _ �efrigeration <br /> � Grease trap t oodstove <br /> �o�:.drains _ Other <br /> Olher <br /> i <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> ' I hareby ceritify thal I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work witi be complied with whether specified herein or noL The granting ot a pertnit does not presume <br /> to give authoriry to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> I construction.Thal I am authoriz_d by the owner of this prcperty to pertorm the work for which applicalion is made and I comply with the <br /> I State Contractors i a�w,18.2T o�t and 296.200 t AC. <br /> ��,�'�'�, L"���"� ��`�3""`( <br /> Signature of OwnedContractodAuthorized Agent aate <br />