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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, 1NA 98201 <br /> 425-257-8810—FAX 425-257-8857 —www.evereVV�OVVpRrg <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS r PARCEL TAX I.D.N PERMIT N <br /> 1U'�l.Z �5—flr SE v�34Gq��3�7 �j� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITYIZIP PHONE <br /> T�,.�IuS�rYCoH5�1���r�� i� Pv. i3r�j� 8fo`(4o p4��u5 rtx 7S�'8/ <br /> TEN NTNAME CONTACTFORPERMIT PHONE � mp�A�f$i9A-Ca <br /> G�se (3 ,`li l.Y��� 3Gv- yz�-�sz.s- � <br /> caNrRncTOR O,�ey-U�S���N�- U�1 's J �R�B Nw7 9y so�f h cirnzir 3 GoP yz��-�a Zr <br /> CONTR.LICENSE p����o3gQ � �� Wy� U�UaN �� �8z�3 <br /> USE OF BUILDING i HEAT SOURCE CONTRACT PRICE OF WORK <br /> I�G�. k �Eledric _Gas_Other �7 C%��, �— <br /> / <br /> WORK DESCRIPTION � <br /> 2.� �4�� wa �� s � ��, s �.,� '� � ��use s,9kS <br /> 2 w"-`'t s���s, �'c,>;v��� �-(rPes ���(�r��1 si��� : <br /> , <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FI)(TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> ToiOt AIC–air han(3�1�g und<_ <br /> –ath(ub Forced air systems <br /> i avatory(wash basin) Gas piping <br /> Shower t ater heater <br /> hitchen sink C disposal Gas freplace <br /> �ishviasher Gas range <br /> Clothes washer Clothes dryer <br /> i aundry tray oange hood <br /> Sink(service/badmopletc.) Exhaust fan <br /> �"ackflow preventer eeat pump <br /> � rinal �nd heater <br /> arinking Fountain –oiler <br /> Floordrain � oefrigeration <br /> Grease lrap 1 oodstove <br /> 000f drains Other <br /> Other <br /> i — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7f05 <br /> I hereby ceritify lhal I have read and examined this applicalion and know the same to be true and covect All provisions ol laws and <br /> ordinaces goveming Ihis lype of work will be complied with whether specifed herein or not. The granting of a permit dces not presume <br /> to give authority lo violale or cancel the provision ol any olher stale or local la�s regulating conslruclion or the per`ormance ol <br /> construciion. That I am authorized by the owner o(lhis property lo perform the work for which application is made and I comply with ihe <br /> Stale Contractors i aw 18 2 oCl and 296.200 t AC. <br /> V��-�-c�� �(�2c� -c� � <br /> Signature of OwnedCo riraclor/Authoraed gent aale ` �� <br /> IZ <br />