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� • ZZ3 oL <br /> PERMIT APPLICATION I � L�'��Q�� D f <br /> C I T Y O F E V E R E T T P E R M I T S E R V I C E S �ri� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Stl' O 3 ZOO4 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> . . .. .... ............... ...... . <br /> CITY OF EVERET <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NQTy�SfIF{�M�Dc Servic p <br /> SITE ADDRESS�� PARCEL TAX I.D.N PERMIT� . <br /> tf 1 vc, 5� /o!-c. aoS 4 0010 I 60l � l - <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITYIZIP PHONE <br /> I171IYNt� Sa 96z3 3 z "'� St s� ��.,fF- c�.� �fzs= 33 �s� $ <br /> TENAN7 NAME �ONTACT FOR PERMIT PHONE <br /> �N fnl.v.o5 f rt scb.h,ll S-fevc PLo� !, �/ZS- 776' l'C $35� <br /> CON A OR Gr'�, rry �y��,� i o ADDRESS CIN21P /� PHONE <br /> / `J�{O o H�Jr�iSov R�� "T j^�� <br /> CONTR.LICENSE# pL�r�Nco'7�G�'h £VLre.{f, I,i.�( 96'Z �3 776 '��35^ . <br /> ,P <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �`� yd2. �`� 3 <br /> Sc�+�v L _Eleclric _Gas_Other 4 <br /> i <br /> WORKDESCRIPTION /N5�4« �ff Sd{- O.� Pq„� cti/.v,vo( L�ffcig � C�) h'oc�uLc <br /> a,u r 1«- u.a7. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Balhlub _ Forced air systems � <br /> Lavatory(wash basin) _ Gas piping � <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace ��,. <br /> Dishwasher _ Gasrange �, <br /> Clothes•,vasher _ Clothes dryer <br /> Laundry tray _ Range hood <br /> � Sink(servicelbar/mop/etc.) _ Exhaust fan �. <br /> BackFlow preventer _ Heat pump �. <br /> Urinal _ Unit heater �I <br /> Drinking Fountain _ Boiler ' <br /> Floordrain _ Refrigeration . <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other _ — — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceriti(y 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 whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any olher slate or local law regulating construction or the performance oi <br /> conslruction. That I am aulhorized by t owner o his property to perfortn the work for which application is made and I comply wilh the <br /> Stale Contractors Law . 7 RC Ad C. <br /> Signat Ow edConlractor/Aulhorized Agent Dale �Z <br />