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. � <br /> — �' � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �ITE ADDRESS pARCEI_TAX I.D.# p�RM�I�j�(' <br /> a33'3 ���'f�' A �� S� Z US" LUa zo37ov �j =��/ - � �' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNFR ADDRESS CITY/ZIP PHONE <br /> � ��,w �7371 N� b �t �o�.� �z� �� �...�'�,��r �..f y�s �r�� -�sa3 <br /> TENAfiT NAME CONTACT FOR PERMIT PHONE <br /> S�g�- Gh✓e.. S-fc�t_ (�L o��l, �{l�y"- 77� - �'if 3S <br /> CONTRACTOR ��,y�. �VCu•,i Cc �DDRE55 CITY2IP PHONE <br /> y �yo� �a,.�•u.� ,Z.J �15= »E - s��3s- <br /> CONTR.LICENSE# <br /> /.3c.rr�/NGG '77c.h. �y�cr�(� � l�C2Oj <br /> / <br /> USE OF BUILDING I -- HEAT SOURCE I CONTRACT PRICE OF WORK <br /> G�JN�,_. Electric Gas Other �O 6� 3 yb. O � <br /> � WORK DESCRIPTION <br /> /.vsla[c ��l srf oF rcv��s� ��.�, �4a,v,,�c.� i, � <br />' /t�F�•5 �l (i) ti,v�.G�c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTUkE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Ga�range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(seivicelbadrnop/elc.) ' Exhaustfan <br />� BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drein Refrigeration <br /> _ Grease trap Woodsiove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I hereby ceritify that I have read and examined ihis application and know the same to be true and correct. All pro�isions of Iaws and <br /> ordinaces geveming this type of work�vill be complied with whether specified herein or not The granting o(a permit does not presume <br /> w give authority to violate or cancel tha provision of any other state or local Iaw regulating ;onstruction or the performance of <br /> cons;ruction. That I am a rized b ner of this property to perform the work for which application is made�and I comply with the <br /> Slate Contractors La 27 R a� <br /> /� ' <br /> Signat � medContractorl.4uthorizedAgent Date <br /> I — Z <br />