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; i <br /> PERMIT APPLICATION 9�oss <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C'0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> (o d�'f Z � D4 . Z'6b � _ �c G�l-�e;i� <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> tol. �4+�►M(.f�,eruf S[r�c�C) � g'41� SU SMvD6�.(. Sr. Ti�►�,e,a , O,C 4�Zz3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SaMaG� ►�'lEa Y�licu�N.Ec. /�ri.�oop IE/zi'�y43-9ZzY <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> 1'�G,�t,is�►t�cK���.,zwe. �30 �s3� �� M/E �Ow,•wo,u,N �Yoa'Y. <br /> CONTR.LICENSE p �LS��C3��ILZy <br /> IM�wI.�rwi i 4(,'c car <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> A �M�L�L _Electric _Gas_Other <br /> (:[l <br /> WORK DESCRIPTION <br /> Tn��tN�,t- L�� T�N�- � (I) Iloi[ Rrag v- ilti//�1 W►�TIGR- 1L ��)REiA1b6�c,�t.ns� <br /> �,+W C1) Cr.FFiEL �'MrMcE�t. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling wiits <br /> Ba1hWb Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> _�_ Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry Uay Range hood <br /> Sink (service/barlmop/etc.) Exhausl(an <br /> Backflow preventer Heal pump <br /> Urinal Unil haaler <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Ruof drains Olher <br /> T Other W4Tf..LTo�'i�EE�N�{�K/t. — <br /> ! W�4?�C�IIt_���I�J4�d/tn�C — <br /> � NasE (3�t3 <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and kimw ihe same to be lrue and correcl. All provisions of laws and <br /> ordinaces govem;ng Ihis type of work will bc complied wilh whelher specifed herein or noL The granting o(a permil does nol presume <br /> to give aulhonty to violale or cancel Ihe provision of any olher slate or local law regulaling construction or lhe performance of <br /> consUuction. Thal I am aulhorized by Ihe owner of this property lo perform the work for which application is made and I comply with the <br /> Slate Nracto Law 27 RCW and 296.200 WAC. <br /> �� �� ������ <br /> Signature of OwnedContractor Aulhorized Agent ale <br />