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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EUERE�, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMI7# <br /> 10�33 1911, �:�e S.� `i$�� I Gb5 s-5' por.�p (��i�l;� `�7 O - O.S� <br /> �LEGA LOTI NO. BLUCK TRACT <br /> DESC. 5���,tc IOI <br /> OWNER DDRESS CI�21Mw�s pHONE��S�, (��2 <br /> 5:����, l�k. I���;« +- �cc 63a� � 3 � � � 5�. � � � `►ds-3S5- �i36 <br /> TENANi NAME I .��OC,9�,' n`CONTACT FOR PERMIT �"'��➢j��� � <br /> �c,r L �Jes`�u,�_. ._ { � ,. �� 5�7�! -7 " � <br /> CONTRA OR �,��`�� DDRESS CITYIZIP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� � t ��� I�'✓� Eledric �Gas Olher �C��� — <br /> WORKDESCRIPTION 5,�,,J ����'n ��;�i„� �.� �Ih�•^ r�o��- S �rh� ��r^ � uoa�i �..��I�S {" <br /> �ur5 �+:nJ. �n'� 5�4�-�oe� W'��nl5�;nq �+..n�;..q (7•,nc�o� [e.��',. ',nr��wu�:� ��IUo�•,�J . <br /> pl� �1��� ,�_,I , �.�,� H� J J J <br /> m��n(� l�. <br /> J �� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUkE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />� Toilet A/C-airhandlingunits <br /> � Bathtub � Forced air systems <br /> Lavatory(wash basin) �C Gas piping <br /> � Shower Water heater <br /> itchen sink&disposal Gas fireplace <br /> Di washer as range <br /> � Clot s washer thes dryer <br /> � Laund tray Ra e hood <br /> Sink(se ' e/badmop/etc.) � Exha t fan <br /> � Backflow p venter � Heat p p <br /> Unnal Unil heat <br /> O Drinking Fountai Boiler <br /> � Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof d2ins Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 , <br /> I hereby ceritiy that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be compiied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.That I am aulhorized by the owner of lhis piupeAy to perfortn the work for which application is made and I comply wilh the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> „�9"`� �i-a G -�e�' <br /> Signa�er�rac or/Authonzed Agent Dale ' <br /> c, � <br />