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( +. <br /> PERMIT APPLICATION <br /> CITI' OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 p <br /> 425-257-6810—FAX 425-257-8857—www.everettwa.org I Z -' �G ` �' <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM z,vNE9 fv2 CuN• �B�s. <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT N <br /> IS `3wa�.w 8�01 aa `f'.�2'�`� 200 '300 /ao 0 0 1 <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. z�_� 2 `352 �U� �Y1'L.� 'Psook vol '� Pl. .. � <br /> OWNER AODRE53 CITY2IP PHONE <br /> 5,�-�� �Ne �121 12y�. p,,<. NE. �icP,Pn,..K , wA qSooS �/�15) �SS• 4 `�`f`�' <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> SPN('�. ��K V T"T C2o�° � 482 - Soao <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ���r� e�M�.r�,.--P �-�-ti.��-��,;, go�- w, H��.k�,- s-r. 1�..{� 98o32 �as3)8`13-3100 <br /> CONTR.LICENSE� <br /> �I-.�-r� CCo2oc'P �- �" ' D� <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> K/ t�-�;-l C,w�>,-.� s-��.a — L�. _ 5 •°� <br /> Electric Gas Other O� Ooo <br /> WORKDESCRIPTION —t_p,,,�M-� �M.ryp,rLf�a,�. 'T i�+'�tv�.e.rC �Jl.C.�rC 4..c� Fin1�S.�` fl�- v�'*"Q.(' <br /> C�r1 c-{y,..��-�-I- � o_ s;c�^d F�,y,,,} E,..`�+�—� SI�� o..�dZ N�2�.✓ 1�;�-'Y' <br /> �..�v��A.�.��.rn-� F,�f�w.(��14,.-� , �-t'°,�-�t�-r—� -T' I r�Je�v�re �,I oN - �a��..� l..in.lQ S <br /> c�.......Q �N- � n t2c.�., c�li,�.—� .� ,s-�-i.:. �-�..�ec i e.... d G'.,s.Qs . <br /> PLUMBING -� � MECHANICAL <br /> NO. NPE OF FI%TIIRE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilet A!C—airhandlingunits <br /> Bathlub Forced air systems <br /> � Lavatory(wash basin) � Gas piping �N,►�� <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher � Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> � Sink(service/bar/moo/etc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnai Un'�1 heater <br /> Dnnking Fountain _ Boiler <br /> � Fioordrein _ Refngeration <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify lhat I have read and exemined this application and know the same to be true and correct. All pro�isions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting ot a pertnit does not presume <br /> to give aulhonty to violate or cana:l the provision of any other state or local law regulating construction or the pedormance of <br /> wnstruction.That I am authorized by the owner of this property to perform the vrork for which application is made and I comply with the <br /> State Contrectors Law 1827 RCW and 296.200 WAC. <br /> \� � ^ 2 ^0 �{� <br /> Signatu�ner/ContracrodAuthonzed Agent Date �� <br /> L <br />