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_i - -* <br /> . <br /> PERMIT APP��CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'I <br /> 425257-8810- FAX 425257-8857-www.everettwa.org ;)�✓ J�� _ � � <br /> APPLICATIONS ARE ACCEPTED FPOM 8 AM TO i PM -DEBR 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS u��� PARCEL TAX 1.0.0 PERMIT N <br /> l�� � +� s -� ac��1b 210 3 � �. ��� - <br /> IEGAI LOT N0. BLOCK TRACT <br /> DESC <br /> OWNER AoYo�ss . L�`�VevtSRcl �TY/L��e�ONE (�.�`���/ ? <br /> �r�� J7 v <br /> �- G �� �, �r�w� � IV I�� . *�zc,o �Z�o <br /> TENAN AME ` CONTACT FON PERMIT r(Pvl✓J S f�KUGti �PHONE <br /> /1 <br /> ' �Y'�n ���'��Yr�., y25"•33y•a57 <br /> CONTRACTOR�C_ �� i15 �OV�. ADDRESP CITV2IP PMONE <br /> JQ /4 <br /> CONTR.LICENSE N�G�Q C�(I�Oy(��� <br /> USE OF BUILDING I — HEAT SOURCE �ONTRACT PRICE OF WORK <br /> 'l'�F� Electric �Gas_Other <br /> WORK DESCRIPTIJN <br /> �� <br /> �y�z-Q� <br /> PLUMBING MECHANICAL <br /> NO. TVPF OF FIXTURE OR ITEM NO. 1YPE OF FI%TURE OR ITEM <br /> 3 Toilet � NC-air handlin3 units <br /> Z Aathtub � Forced air systems <br /> � L avarory(wash basi�) �: Gas plping ���I <br /> � Shower � � Water heater <br /> � Kltchen sink 8 dispasal _J_ Gas fireplace I <br /> ___�_ Dishwasher � Gas range <br /> � Clothes washer � Clothes dryer <br /> Laundry tray Renge hood <br /> Sink(service/barlmop/etc.� � EMhaust fan ;,��� <br /> BackAow preventer Heat pump <br /> Urisal Unil heater <br /> Drinking Fountam Boiler <br /> Floor tlram Reingeration <br /> Grease trap Woodstove <br /> Roof dreins Other <br /> _ Qther — -- �� . '. <br /> — — - �� - ��1..,� � <br /> CI1Y OF EVERETT LOCAL SALES TA)I CODE IS 71 ��1� <br /> I hereby centity Ihal I have read and examined this appllcation and knrnv the same lo be true d correc(, I��(lro�ons of lawv and <br /> ordmaces goveming thls type of work will be comphed w�ih whelher specified herem or nol Thg, iAdbl�:�xmit�dces not presume <br /> to gwe authordy to vio��!_nr cancel�he provision of any o�her sta�e or local law regulahng conSlr��oF�he peAormance oi <br /> construction That I,m autho�iz?d by Ihe owner of Ihis property to perform tho wr�rk fw wfnch application is mede and I wmWy�+nth the <br /> State Conlr�do�4L�w 1�17 CW and 29G 200 WAC. <br /> �� � � �G�, � �.��� � � <br /> n ure o ontrattor/ uthorized�gOT— at-6 8 � / 1 <br /> _� /j. <br /> �� ,� ,�.�� J <br />