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t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERM{T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> zuQ� <br /> � � � �� -�. � APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �� ..(Q �-�O <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> . . .�ulj�� K�MIiM QqV.L P.D. BLO(e�• C � � VU <br /> �M <br /> LEGA LOT N0. BLOCK TRACT OR OUBDIVISION/ <br /> OESC. <br /> OWNER ADDRE39 CITY2IP PMONE <br /> �OH,r�u.Nz.ty �7tr,�ir -I�� Na�e.OeSnv 0.o Evev�rc ! 9'67p3 �4251 35i• �433 <br /> TENANTNAME I CONTACTFORPERMIT PMONE (1�.) LSS • �150 <br /> Cu�+�M�+1.L�`I TTANJu S'A2E SN1Ppy E#IAII .TA'LESPB�lE4. NEf <br /> 6Q4�.[Y CoN;.,cauc�I_crv <br /> CONTR.LICENSE/ DOtS SE ZbT" ST. M��' �`"`�� �����'L�- Bb\4 <br /> �v�.��,o ay sc 9•ovo <br /> USE OF BUILDIN6 HEAT SOURCE 1�CONTRACT PRICE OF WORK <br /> Lucrea 0.ewe cq�zx�u.s �Elecinc _Gas_Other w��O <br /> WORK DESCRIPTION <br /> PLPC1a�C� TEMQpO� W-J1M1 PooM fn�'�t'-�'1 OV.\LY�.D& UF gu1l.D'1f��^ L orJ NOWN 61DE <br /> [oo. Con�..NW1zy ThANS'LT• UbE DutttY.. $�.04.. C RFI�oDE�.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> - Toilet i A/C-air handling uni!e <br /> Bathtub ForceA air systems <br /> �_ Lavatory(wash basin) _ Gas piping <br /> Shower - Water heater <br /> Kitchen sink 8 disposal Gas hreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Watar heater Range hood <br /> Sink(service/barlmop/etc) Exhaust fan <br /> Backllow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeiation <br /> Grease trap Woodsrove <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL 9ALES TAX CODE IS 7106 <br /> I hereby ceAity thal I have read and exammed this apphw6on and know the same to be We and correct. All provisions of laws and <br /> ordmances goveming Ihis type ol work will be comphed with whether spea6ed herein or not. Tha granBng of a permit does nol presume <br /> to give authonty to wolate or cancel the proviswn of any other state or lowl law regulating construction or the perfortnance of <br /> consirucUon. Thal I am authonzed by the owner of this property to perlorm the work for which applica6on is mede and I comply with the <br /> Slale Contractors Law 18 27 RCW and 296 200 WAC <br /> � �/ " _(O.ISTf�J V �ihi�1 <br /> SignatUre d{hvnerlConlractoriAutl onzed A ent oate Ih <br /> 1•^ <br />