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I-- P�RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3�00 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881�- FAX 425-257-8857 -www.everettwa.org <br /> � <br /> �, ;', APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 p�' On� <br /> SITE ADDRESS PARCEL TAX I.D.# � PERMIT N <br /> �.� . ,,;:v=. ,7 a.,zao,r, ��� a,.L�r ob� 906 � 700 SGvatl. �R-oo2 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. CAC���" Of�J P��NF fIFiL7 0�. <br /> OWNER ADDRESS CITY2IP PHONE �_H�S <br /> � �.N ,,.. K�� c;��,,� ,,� ����a i iarR�oc�7 � �U 'r�-��i 96�o�f 3ss— 3ii � <br /> TENANT NAME CONTACT FOR PERMIT PHONE y'Z!�_ �- a3�a <br /> r�a,'21< WOutFn/ 'rAx y�5-��2' 9y&2 <br /> s�ov�,z oua�_ E-��u� <br /> ONT ACT 1.tJ ryyF��� ADDRE S �t�c� i0v(���.�,A � <br /> rrvv�,c��w 2,53-463- 537� <br /> CONTR.LICENSE# IZNN�mF.mkq53oq `VQ� 9��a <br /> USE OF BUILDING �� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �I � I _Electric _Gas_Other � .�,�,,'�� ',. � � <br /> WORK DESCRIPTION <br /> conK,�vc� `� SHqP�p S�Nbyj' PO�, GiiM✓= MT <br /> fl� L��3o�"z� 30o S�p/t �c�}c+} SiUk <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower j .,. _ Water heater <br /> Kitchen sink&disposal ��' � �� Gas fireplace <br /> Dishwasher � " _ Gas range �, /� <br /> Clothes washer • Clothes dryer �U <br /> � Water heater Range hood <br /> Sink(service/badmopletc.) _ Exha�st fan <br /> Backflow preventer Heat pump <br /> � Urinal . _ Unit heater i <br /> Drinking Fountain __ Boiler � <br /> Floor drain Refrigeration i <br /> Grease lrap � _ Woodstove '', <br /> Roof drains Other I <br /> vther <br /> CITV OF EVERETT IOCAI SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be[rue and correcl Alt provisions of laws and � <br /> ordinaces goveming [his type of work will be r.omplied with wnether specified herein or noL The granting of a permit does nol presume I, <br /> to give authority to viclate or cancel the prevision of any other state or bcal law regulating consWction or the performance of ��. <br /> construction.That I am authorized by the owner of this property to perform fhe work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. '� . <br /> 1 � i <br /> l� , p �I I <br /> . .. �. t .\ 2i.`., ; `� i' � � � � , 'i . <br /> Si��nature of OwnedContractor/Au horized Agent Date �- ! '�, <br /> � � i <br /> i <br />