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• _ - - -_ <br />_ _ - I <br />PERMIT APPLICATION <br />I CITY OF EVERETT PERMIT SERVICES I <br />3200 CEDAR STREET, EVERETT, WA 98201 ! <br />I, 425-257-BB10 - FAX 425-2o7•8857 -www.evere�00HpRrg ' <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J"a� ��� <br />I SITE ADDRESS � r1 S 13���`L;�T �� <br />� <br />I iFC;AI LOTNO. BLOCK � <br />O[SC <br />OWNER <br />,3���a.l �'�,llc<<��k �.(L <br />PARCEL TAX I.D. N <br />2� t> j 3Cxt�yc� G� c_, c� <br />TRACT <br />PERMIT N i <br />��,-:vS-1 � <br />1,������<<TI�kE� Au�N .X-�.�It� `����� <br />TENANT NAME CONT CT FOR PERMIT PMONE <br />�;«k,.�+�,i P��,� �3;1P17.��k 3G�-����-�32s- <br />CON ACTOR A�DRE55 CI /21P PHONE <br />���cy�-� 5,����-E-A�l.,�.��,s��«�����Hw��r�.5����� 3GU_t�2y-�325' <br />CONTR.LICENSEM1A����, r �/\ „ j&/�� ��UI�KI uQfUu� ���73 _ <br />�„ � Tt.� .r <br />�� USt OF BUILDINO <br />� `.�r 5����� <br />I WORK DESCRIPTION <br />I <br />HEATSOURCE <br />__ Electric _ Gas _ Olher <br />. <br />,-.x.��--�--�,� � � ., � � � �� �� �,��. „ �, � � <br />NO. <br />u <br />TVPE �F FIXIURE OR ITEM <br />ToiOt <br />—alhWb <br />i avatory (wash basin) <br />Shower <br />hitchen sink C disposal <br />e ishwasher <br />Clothes washer <br />i aundry Iray <br />Sink (servicelbadmop/etc.) <br />—ack�ow preventer <br />� nral <br />a�inking Fountain <br />Floor drain <br />Grease trap <br />000l drains <br />Other <br />CONTRACT PRICE OF WORK <br />3 ���ti�`� <br />� <br />NO. I TVPE OF FIXTURE OR ITEM <br />NC — air han(3Qig unrts <br />Forced air systems <br />GaY piping <br />t aler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />�ange hood <br />Exhaustfan <br />eeal pump <br />� nit heater <br />-oiier <br />o efngeration <br />t oodstove <br />Other <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby ceriLfy that I have read and ezamined Ihis apphcation and know lhe same to be true and covect All provisions ol laws and <br />ordinaces govermng this type ol work will be complied with whether specified herein or not The granting of a pertnd does nol presume <br />to give authonty to violate or cancel Ihe provision of any olher state or local law regdaUng tonstruction or the pedomianw_ ot <br />construction That I am aulhonzed by lhe owner of lhis property to perform tha work for which application is mede and I comply wilh lhe <br />State Contractors i aw 18 ZT oCt and 29G 2001 AC. ,J <br />J ( �J -C>�j <br />/L <br />