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-- � — --- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1r � aU �"-) <br /> SITE ADDRESS PARCEL TA% I.D.N P MIT N <br /> ,;7o�v l�J. C�a no �� �f Wa���� �r� /0 - � <br /> LEGAL lOTNO. BLOCK TRACT <br /> DESC <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �rva�� uQ {�o� w�.d L[.0 �/'.x�s a13 �` st s� Px� II <br /> TENANT NAME CONTACT FOR PERMIT ' PHONE <br /> G I s �.n�erio� �.�n�l� � � ��cly ��u i e � �53- (���- Ula8 <br /> CONTRACTOR ADDRE89 CITY2IP PIIONE <br /> Tnrum�iaw:I A V1��n..r� Ia � N.(T.s+. 'Tac�„-� 253�1oL7-�{/�8 <br /> CONTR.LICENSE N �}�}jy0 3 <br /> "�'Acrrn�H iy4 RYv1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electnc _Gas_Other (��"� <br /> WORK DESCRIPTION <br /> av�;�1�•.l� � Nai,.s �Wluv�-� w��-l. c�'Sr�ci�R n.-� bl�c� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF fIXTURE OR ITCM <br /> Toilet A!C —air handl�ng units <br /> Bathtub Forced av syslems <br /> Levatory(wash basm) _ Gas piping <br /> Shower Water heater <br /> Wichen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clo�hes washer Clothes dryer <br /> Laundry tray Range hood <br /> Smk(serncelbar/mo�+.�etc � Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal Und heatei <br /> Drmkmg Fountam Boder <br /> Floor dram Re6igerabon <br /> Grr,ase trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EVERETT LOCAL$ALE9 TAX CODE IS 7105 <br /> I hereby cenldy�hal I have read anA examined this appiicalion and know the same to be true and correcl All provisions of laws end <br /> ordmaces goveming ihis type of work will be complied wdh whelher specihetl here�n or not The granhng ol a pennd does not presume <br /> to grve authonty to violate or canczl the pr�asion of ary other state or local law regulahng conslruc6on or Ihe performance of <br /> consirudion That I am authon3eA by the owner of ihis property to pedorm ihe work for which apphcahon Is made and I comply wilh the <br /> State Cb'niractors L�18 27 RC W an 296 200 WAC <br /> � 1, � % ,i�- �'�� �G� ' .=�i O�. <br /> Si�qn fure of Ow r onlractorlAulhonzed Agent ale �, <br />