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, RP�!'�nSr-�ii <br /> �� PERMIT APPLICATION ��'��"` ��` � <br /> CITY OF EVERET7 PERMIT SERVICES �«`J�"n <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCE?TED FROM a AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> l��d �7 ' l/ �W 80 • 5 DOZJ - �/07 •,.30 � �i'�%4 - � l <br /> LEGAL LOTNO_ BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��i /i'��Llt/�C? �;:s�'��/ L�'��;,� �3 di �//dl/-/gv� �`Sdv <br /> LC c��, �,�f,- 9e���/ <br /> TENANT NAME CONTACT R PERMIT pHONE <br /> �m�,��vs �ss-�s't�r/ ��� h c. �a�'�, Qdi�ifdn/ 10l :3�8. 3.z d <br /> CONTRACTOR DDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C� � L�v�� _Electric _Gas_Other �I <br /> WORK DESCRIPTION �I <br /> i / <br /> �'C'[,C%5� �' r' i�L� �C/�t"� h P/ �' il �t �tGx Lc-C /1�j (� / <br /> � J <br /> PL'JMBING AAECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handling units <br /> _ Balhtub Forced air systems <br /> _ Lavalory(wash basin) Gas pipinc� <br /> Shower Waler heaier <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas renge <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ BackOow preventer Heatpump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> _ Ftoor drain Re(rigeration <br /> Grease trap � Woodstove <br /> Roof drains Olher <br /> Other — <br /> —I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined!his application and know ihe same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> to give authority to violate or cancel the�provision of any other state or local law regulaling construction or the pedormance of <br /> consiruction.That I am authorized by the owner u(this property to pedorm ihe work for which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW andi296.200 WAC. , <br /> � � I <br /> - �����. � i . r ;� � � , i� j <br /> , � �� � �,�,. � -,: �-� � ( I� �G� <br /> Signature of wnedContractor/Authorized Agent ' � te <br /> ERIC MENDELSOHN �IZ <br />