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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982C1 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � �zZ-�� <br /> SITE ADDRESS ��03C �y 7W��r kvk�ts�oc) PARCEL TAX I.D.# PE MIT�#; <br /> l� r' wi ZIC1S~�70Q20�600 )/L�'�Z <br /> LEGA' LOTNO. BLOCK TRACT Ay(_ � <br /> DESC. s�CJ�Il�c•���� <br /> OWNER I AUDRE55 CITY/ZIP PHONE <br /> Sae DD, oa�' co►t�7zc,i- oF �c.GL z22. G � Yo1i• T�• SC H�rlc�ee� wA (ss�z <br /> TENANi NAMEI� CONTACT FOR PERMIT PHONE <br /> ��O lOt(,C. USA �-1-i�-1 ���,ra,��.c� 5 Zo�-3�4— yz`7�j <br /> CONTRACTOR,1'jC•, ADDRESS ciTr2ir PHONE <br /> �,,.►�.y� syyr�.� �����P �4w — So+�, s�-. sw,c3i v�!�aJs�.9 �Z.r- 4�,- oo� <br /> CONTR.LICENSE# OQ�'G,. Q[-G ` �8'M F �UP�YJ�"�� w!� 1&Z�3 �^l.�G NGGea�t�P�- <br /> OFHcE='425- 74o-Z37o <br /> USE OF BUIL�ING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> N�� _E�ectric _Gas_Other � �O�e op � <br /> WORK DESCRIPTION J?�,,�Q�i„�;��F Si;4.G ,�� Q,4'�,.��ftnAS On. '�'��° � <br /> � �.�. <br /> (oP�- M,o-�,� �jVIIG�in[ • C.br�S�l'U��- ►.��ec,J W�re,��5s Gw'ec�. -1GwF- inc(uc�. <br /> 40' Pol�., P-�tcP�o Ca-(v�.�s On Slab,-4�1un� . � itJ tJC (ro�nte-�. xF proP'�". <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEIA <br /> Toilet FVC-air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink S disposal Gas fireplacc <br /> Dishwasher Gas rangc <br /> Clothes washer Clolhes dryer <br /> Water heater Ran� �hood I <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow prev,;nler Heal pump <br /> Urinal Unit hoater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslova <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby corilify Ihal I have read and examined this appiication and know the same to be true and corcect. All provisions of laws and <br /> ordinaces goveming lhis typo o(work will bo complied wilh whether specified herein or not The granling of a permit does not presume <br /> to giv uthoriry to violate or cancel the provision of any other slale or loral law regulating construcUon or the pedormance of <br /> con ru t�on.That I am a ized by t wner of this property to perio m the work for which application is made and I comply with the <br /> St e � traclors Law . W a 96.200 WAC. <br /> �(. � �! ' b!`O0� <br /> ign ure o nedConlractorlAulhonzed Agenl Date <br /> �Z <br />