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PERMIT APPLICATION <br />C' <br />LEGAL LOT NO. BLOCK TRACT <br />DESC <br />OWNER �O�•�' rtZf � ADDRESS CIT!/ZIP PH`ONE2�j(�•Zy3'9 <br />G(/o—S'eu��(1.�5 Lr.1L 320 1Dlo�A1IG . ►�i6 �t�..eJbE WA q&oo4- <br />TENANTNAME CONTACT FOR PER T PHONE ti <br />.14e��s wVA �e+'Ics►'l zca • az4• 2.s4;3 f f <br />.+-L.l.¢.lz <br />�2�Q�q-'•-�)��-��`•�'-�`'�z A-,—,� )�L. L.r� Innu$�.AS6C[. 2.06 • �p-054R Cc <br />CONCONTRACTOR.5 G* ADDRESS CITYIZIP PHONE1�.. • ✓L2'�, Z)�1 <br />1501 ).J. 200t"I'l- 5-t' <br />CONTR. LICENSE SF-FnMl?LI/J� / (,v A, / k 1A <br />fir'• �.�o �Ir;r��•g•�' � �IR133 <br />USE OF BUILDING HEAT SOURCE CONTf .CT PRICE OF WORK <br />61�iGE — 4�1R�i{-%M�S�i• �Electnc �•Gas_Other �I/05100. � <br />WORK DESCRIPTION <br />l%at1P�1 <br />+1fl T.0 ! _T�°'�' <br />PLUMBING <br />MECHANICAL <br />NO, <br />TYPE OF FIXTURE OR I'EM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_Q <br />Bathtub' <br />Forced air systems <br />Gas pipin <br />Lavato�(wash basin) , <br />shower <br />Water heater <br />.. <br />Kdthen sink.B�iMwal <br />Gas fireplace <br />0 <br />Dishwasher /� <br />Gas range <br />Clothes washer � /1 <br />Clothes dry � <br />Laundry tray � � a/ <br />Sink r. <br />Range h9aQ <br />Erha fan <br />(service/bar/mop/etc.) <br />— <br />BscTcilow p nter � (� r <br />Uriraley(rl_J <br />Dunking Fou in /► <br />He pump <br />d heater <br />er <br />=Floor <br />drain 1 l '�1 <br />Grease tr VVV--- 1' <br />lrigeralion <br />Leodstove <br />Roof drAllis <br />Oth <br />= <br />Othert/_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br />I hereby centily that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />or paces governing this type of work well be complied with whether specified herein or not The granting of a permit does not ?resume <br />to a authority to violate or ncel th ovision r,! any other state or local law regulating construction or the performance of <br />n That I am autho zed by he caner o' this property to perform the work for which application is made and I comply with the <br />La 1827 2CW I 200WAC <br />L�.a- � •/� •ate <br />tSia—twe <br />of wnerlContrac rlAulhonzed Agent Date <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 - www.evereltwa.org <br />APFI.ICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />�a <br />SITE ADDFR�ESS �, PARCEL TAX I.D. p PERMIT)111 <br />