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� �_ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SEFiVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25?-8810–FAX 425-257-&857–v�.vw.everetlwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �2—a6�-C/� <br /> SITE ADDRESS PNRCEL TAX I.U.t! PERMIJf# / <br /> 55c,� �veY ✓ce;-, W Co393aool0o`I00 � �U� - ��; � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p ,�E o��a_�y� <br /> oesc. � UGI p-UO .�vev�� N�lls DIJ <br /> OWNEfl i ADDHES CITY2IP PHONE (Y�1S� <br /> �cvf-� + Clnr;sl� 5s'o.� F,�e,�J�c� �'�- E�c,-�rtr <br /> I-lelnSr�c�-e � `�SaQ3 353-3�i1 <br /> TENANT NAME CON'TACT FOR PERMIT PHONE �y a�� �� �- �Sa S <br /> E��teY��;s� �.e���9 �omr0.,�y ��p�cl�e l le Keev� e•Mai� iri�cL,�ue. KeenC�e��e [rm <br /> CO AC O Cill�rtS�h si �� � R S NLl ` CT IZIP O <br /> 9 sao�- i��. sf._ <br /> CONTR.LICENSE# S�rv��-e Taco�v��, wA qgc��� (a53� 863- 3 �'31 <br /> cu�-�BESS98`1rY� J <br /> USE OF BUILJING HEAT SOURCE CONTRACT PRICE OF WORK <br /> tl�tovnob�Ie rCYRu.� 'Y SG���S _Electric _Gas_Other $ b(�0� <br /> WORK DESCRIPTION <br /> T�Stc�tla-l-+o�� of � ��ew wat� siy�-,s <br /> PLUMBING MtCHANICAL <br /> NO. TYPE OF FIXTUFiE OR ITEM NO. TYPE OF FIXT�JRE OR ITEM <br /> __ Toilet _ FVC–air handling uni�s <br /> Bathtub _ Forced air sys�ei is <br /> Lavatory(wash basinj _ Gas piping <br /> Shower _ Waten c�ater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer I <br /> Water heater _ Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust fan <br /> 9ack(low preventer _ Heal pump <br /> Urinal _ Unit heater <br /> _ Drinking fountain Boiler <br /> Floor drain _ Relric�eralion <br /> Grease trap _ Woodslove <br /> Roof drains ��h��— <br /> Other — -- <br /> —I — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hcreby ceritify that I have read and examined Ih!s applicalion and know the same to be true and correcl. All provisions ol laws and <br /> ordinaces goveming Ihis Iype of work will be complied wilh whether specified herein or noL The granling of a permir does not presume <br /> lo give authority to viola�e or cancel the provision of any olher state or local law regulaling conslruclion or the perlormance ol <br /> consr�uclion.That I am aulhorized by the owner of�his pmperly Io perform�he work for which application is made and I comply with Ihe <br /> Slale Contractors Law 1827 RCW and 296.200 WAC. <br /> �,�n} ' ,� , �A� �.�� ' l� 6 0$ <br /> Slgria yr o�wnedConlraclor Authorized Agent ^ Date <br /> �(v�( EY�t�Pr�sc; I�ea-s��9 ea�,pa:'u.J `�Z <br /> c� l�J A C�;� . <br />