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L•� <br /> I _ _ _ _ __ __ - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 . �,z� n:' <br /> 425-257-8810 - FAX 425-257-8857 -www everettwa.org •' �i�� <br /> APPI ICATIONS ARE ACCEPTED FROM 8 AM T04 PM <br /> S�I1TE ADDRESS ( PARCEL TAX I.D.N P M/IT ti �n/ <br /> ,7�1:�i - /�� �/ � �� �C. (�' ' '� �" - Z � �� � ` � � 9 <br /> L[GAL LOTNO. BLOCK TRACT � L;Lv �1 r'/""� <br /> �Es� .C�c� n- ot� T�l�r� '� ��:- s�' <br /> OWNER ADDRESS CITV2IP PHONE �J."' • <br /> '�m � ���::,�,� �,-�� � `�/ '; • /l''%`G.F` ,i� �v�ie7l�c�s['�;i nvo / <br /> TENANT NAME I CONTACT FOR PEHMIT PHONE <br /> %c3�Q�29 ye�,�� �,_<,� <br /> �I I�,��n �\ l �nunq I'��,� I r:unr Huildin � � y%t, 7 y-� /r e' <br /> CONTRACTOR Ilr�_'I II\1�1' '�'� tilrl' � CITY21? PHONE <br /> I.�itm�nud. 11'A 'IRII?7 <br /> CONTR.LICENSE♦ .J?5.7d_'-Ih011�1� .1_'S.7d:-155SL<I. _'�111 /��c�����C, 7 �� <br /> I Il' ' I(l\lN('PI'n�1qIJ <br /> ''��' '`:�-- — � <br /> USE OF BUILDING � � .._... _�URCE CONTRACT PRICE OF WORK <br /> �' I �� � <br /> -�/, �,�_r-t�_ Electnc _Gas._Other �'/� �' ;.�i <br /> d � � — <br /> WORK DESCRIPTION /� `. � � I _' J C••� JC C �./�i �C�' �(� /�r-.4.Il�r �'7�(a C �i.�� <br /> � ��.'1. � -I tJC _ 1 <br /> C-,'[i.�,'���� <br /> , PLUMBING MECHANICAL <br /> I N0. TYPE OF FI%TURE OR I fEM NO. TYPE OF FI%TURE OR ITEM <br /> i _ Toilet _ AIC-av handlinp umts <br /> _ AatMub Forced air systems <br /> I _ Lavatnry�wash basin) Gas piping <br /> Shower Water healer <br /> i Kdchr.n sink 8 disposal Gas Greplace <br /> � Dishwasher Gas range � <br /> _ Clothes washer I Clothes dryer <br /> Laundry liay Zange hood <br /> I Sink�service/badmo etc � Gzhaust lan <br /> ' Ilackflow prevent Heat pump <br /> ' Unnal Und healer <br /> ! Dnnkmq F itam BoAer i <br /> Floor dr i Retri ration ' <br /> Gre trap dslove <br /> � R f drams ther <br /> �ne� <br /> -- i <br /> , CITY OF EVERETT LOCAL SAlES TA%CODE IS]105 <br /> �: I hereby centdy ihat I have read and examined this application and know the same to be true antl correct All provisions ol laws and � <br /> ' urCinaces govemmg this lype of work will be complied with whe�her speciGed herein or not The granting of a permd does not presume <br /> j �o grve authoriry to violate or cancel Ihe piovision of any other state or local law regulatmg construcdon or the periormance of <br /> � conslNcti n That I am authonzed by Ihe owner o(Ihi propeity to perform the N�ork for which apphcahon is made and I comply wdh ihe <br /> I, Sldte Co ractors Law 18 zIRC and 2�200 W � �' <br /> /� / I <br /> C �,� � �� �� � � �- <br /> Sig ture Owner/Con ractovA rthunzed Agenl Date '/ <br /> L <br /> - __ _ _ _ ___ _ . i <br /> �O 4� :�`� <br />