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. — <br /> PcRiUIIT APPLICATI(��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREIT, WA 98201 6 0�► <br /> 425-�57-8810- FAX 425-257-8857- www.averethva.org � � i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTEb I <br /> SITE AODRESS PARCEL TAX I.D,q � ,nP�ERMIT# <br /> (r ll 5.5 U �a �d�d. ��oy��{ �o�, 00�10J I /yl��� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � <br /> I <br /> OWNER ADDRESS CIMZIP PHGNE I <br /> 1.6R R�aE{,� i�1�U ( �;�cy� K�1�N211 A�,e»ue Trvli,e �� �l�lol� �j,� �155 �l-�_ <br /> TENANT NAME �r— CONTACT FOR PERMIT PHQNE <br /> CU�Unt�)i2 �1(1�i�i��A�;tU� I �ir �l �1��)S�C�- .?,ol� (�G`� .�l(�8 I <br /> �u^i/�_��p�R ( l�� AQDRESS C(I�'�Y2�1�Pp,� PHONE/�//, 2 � <br /> , �� �l k ,7y54�m1 ���'(�,1 �� Ntv�Gr��,U��p ,'� �(j� X"dn'e q���� J+N j�7 rr� <br /> CONTR.LICENSEA ��( N ��1 lA�� OA � �_ � � ��/ G� <br /> �l� �,� <br /> USE OF BUILDING I — HEAT SOURCE I CONTR T PRICE Of WORK <br /> ElecMc Gas Other 5��9�'t� <br /> WORK DESCRIPTION � /� I <br /> I1�S���1� �ik I�cw � oG-('{G� I�C 1.1�1t�S � 'tluORe�.I �eE�{"�`n °��'�1Lu`�. �c�1�5'� I <br /> iVY1� � {'W C�i�11tr� �1.�.'{t2u `st �G�i, a�11�1' Ly�f: Il�w l;Ql1�-�IeSS 5(�I�. S�.1S"�iW1 , <br /> �_ Ck, � ' U�-F�lLS�'r'S er ( <br /> J I <br /> i F�LUMBING MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ItEM NO. TYPE OF FIXTURE OR ITEM I <br /> IToilet A/C-air na�ialing units � <br /> I _ Bathtub Forced air systems � <br /> ; _ Lavarory (wash 6asin) <br /> � Gas piping � <br /> _ Shower Waier heatar i <br /> ! _ Kitchen sin4 8 disposal Gas flreplace <br /> Dishwasher Gas �ange <br /> � _ Clotnes washer Gwthes dryar I <br /> �� _ _ Laundry tray � Rar�g6 hood I <br /> ' _ Sink (service/badmop/elc.) � Exhausl fa.t <br /> _ Backflow preventer Heat pump � <br /> _ Unnal Unit heater � <br /> Dnnking Fountain Boilcr '. <br /> �, _ Floor drain Refrige;ation I <br /> _ Greasetrap Woodsf�ve <br /> Roof d�ams — ���1ef � <br /> Cther — — <br /> — _ _ i <br /> i <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS 7105 i <br /> i hereby r,entify thai I have read and exammed this application ana know tho same to be�rue antl correct. All provisions of laws and ' <br /> orainaces goveming this type of work•Nill be complie0 with whether spec�fieG herein or not. The grenting of a permd does not presume ' <br /> to grve authonty ro violete or cancel the provlsion of any other stare or local law regwaung ccnstructlon or the parformance of �'�. <br /> anstruction. That I am authonzeo by the ownei o(this prcperty to peAorm the work for wnich applir.ation �s mad•3 antl I comply with the <br /> State Cuntractorg Law 1&.27 W ancf 296.200(WAC. ' <br /> ' 'v L n / � <br /> �� � ��• 1, 1 �.� � 0 � <br /> S�S eture or uwner,� on«ac onAu�honzetl Agent � �ate / � <br /> �/Z <br />