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1 ( <br /> PERMIT APPUCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ^I U 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 -m w.everett.va.urg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SIVE ADDR —7* 1 PARCEL TAX I.D.p PERMIT ti <br /> if R?!) <br /> r.5- cu . I - - - 70 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> ;TOW R ADDRESS clTyr_IP PHONE - — <br /> ci to (s X07 e� ,W, EVP.,.01 tt � 6_�2'/2 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> '`j-a t"C U _ �J_(I.M N1 l V1 eqe z-1.2_ "- S,2 2- <br /> CONTRACTOR <br /> CONTRACTOR r ADDRESS CITY2IP PH^NE Z42f- <br /> 7Wf <br /> s 'qM 1' '��i /� t�5rt �•rfCB 33 gZ2 1 w <br /> CONTsR LICENSE k/ <br /> � rr�..�-�� <br /> USE OF UILDING HEAT SOUR CONTRACT PRICE OF WORK <br /> Electric —Gas--Other <br /> WORK DESCRIPTION <br /> 1Vs�R LL r✓O �! - �LLu.y Ll/q LL S.q <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C-air handling units <br /> _ Bathtub Force]air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower __ Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas,dnge <br /> _ Clothes washer Clothec dryer <br /> Laundry troy Range hood <br /> _ Sink(service/barlmopleic.) Exhaust fan <br /> Backflow preventer _ Heal oump <br /> I Innal Unit heater <br /> _ Drinking Fountain __ Bailer <br /> Floor drain Refrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES T/X COUE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorial to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> cons�ruction. T:lal I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Conlractorp Lai 18.27 and 290.200 WAC. <br /> PA <br /> -:�� L617 <br /> Lure of caner ContractorlAuthorized Agent al Ire <br /> v <br />