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PRZMIT APPLICATIc <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PMr— -' (j/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3003 u sino k�' c\_ ,agDy ID OZ). IDOaaO ,41 i ` fCc1 - 0 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE / <br /> ' iiik <br /> TENANT NAM ct CONTACT FOR PERMIT PHONE <br /> • v Zd(o•ZS?� �S3o <br /> mob 10_" _k. 26 \v t • \._. E-MAI �n, . •� 1 <br /> CONTRACTOR I-Vola clatipoLrks ADDRESSCITY/ZIP PHONE <br /> Lt 6 U a S.1 1/4.(‘'' 1'k ‘3t cko t4 2a,ZSD.qS3P <br /> CONTR. LICENSE# <br /> 140 04--- P'I 37q 0 o <br /> USEpF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other l 77: • <br /> � p�S�C�7? L <br /> WO ESCRIPTION 1 l� — <br /> e. <br /> -'L..C "4 1 :. r' . I cL�-( �,,p S -b" 1^'L <br /> PLUMBING MECHANICAL <br /> O. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> oilet A/C—air handling units <br /> B tub Forced air systems <br /> Lava (wash basin) Gas piping <br /> Shower ''- Water heater <br /> Kitchen sink isposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washerClothes dryer <br /> Water heater > Range hood <br /> Sink (service/bar/mop/e .),,, Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater ' <br /> Drinking Foun n Boiler <br /> Floor drain '' Refrigeration <br /> Grease .--p '".. , Woods e <br /> Roof . ains • ` Other 0_1.LJ <br /> O 'er <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to gi ... :uthority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> co .true '.n.That I , authorized by the owner of this property to erform t work for which application is made and I comply with the <br /> St. e Co actors a 1:. 7 •BCW and 2•. 10 WAC. <br /> 4 R \R, 04 <br /> Signatu - -0 .--- ontra oriAuthorized Agent l Date Z <br />