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� ' ' QFc f�5 <br /> �� �, <br /> PERMIT APPLIC�4TION <br /> CITY OF EVER�TT 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 PM <br /> SITE ADDRESS P EL TAX I.D.# PERMIT# <br /> 62 �J9/9 F'ue/'���t [,� �0 Iq00o0o106 i✓11Uu�-o�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# i;iyf/G2 <br /> DESC. c,v J� ���D�� <br /> OWNER ADDRESS CITY2IF PHONE <br /> �sadOn cl�r�eil�er su��w�A — <br /> � �-�5.�. 650 ��c�r� 6fu:+�?�o <br /> TENANT NAME C�O7�NTACT FOR PERMIT PHONE�!' _ 763��7 y <br /> I // ���� �/�fi[/�J E-MAIL I�YIGCf"�Dlv�/P'Ul.°Y�!'GGI1�7 �'� <br /> ��CONTRACTOR � <br /> �'�{Q /�C.LfI �-`!�¢�G�C(�7Y�U� DORESS ITYI2IP P' E <br /> � 727 S• Ken on S-�, s�t���l.e 2�6—��3'17y�{ <br /> CONTR.LICENSEN E�EnC ��q54R�- y / <br /> 7 �ic,Id$ <br /> USE OF BUILDING HEAT SOIIRCE C NTRACT PRICE OF WORK <br /> �Electric _Gas_Olher �� �5� <br /> WORK DESCRIPTION <br /> Z�rr.s��r.lt ���- C'an�if�'on�n� u�r�'f fo s�er(/� �aa�z • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7CTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet <br /> Bathtub � aC–airhandlingunils <br /> — Forced afr systems <br /> _ Lavalory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Oishwasher Gas range <br /> _ ClUhes washer Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/barlmop/etc.) Exhaust(an <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floordrain ReGigeration <br /> _ Grease irap Woodslove <br /> _ Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceAify lhat I have read and examined this application and know lhe same to be lrue and wrrecL All provisions of laws and <br /> ordinances governing lhis type of work will he complied with whether specified herein or not.The gianting ot a permil does nol presume <br /> to give authorily to violate or cancel Ihe provision o(any other state or local law regulating conslruclion or lhe per(ormance o( <br /> construction.Thal I am aulhorized by the owner of lhis propeAy lo pedorm lhe work for which applicalion is made and I comply wilh lhe <br /> State Conlraclors Law 1827 RCW and 296200 WAC. <br /> ��i��f��� 7 -�d - I�J <br /> Sign re o )wned�gvfh3et6dAuthonzed Agent Date <br />