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P RMI'T APPLICATI�N <br /> CfTY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l�-a 6 -o 7 <br /> SITE ADDRESS PARCEL TAX I.D.A I PERMIT N <br /> 1 ra�P Mo�o l -050 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �S4}c�..�a� . T�,� 9�0�rsrs� Qe(i�u� 1-y2r-yss-6vyv _ <br /> TENAHT NAM CONTACI'FOR PERMIT PXONE <br /> �le�s �'�, �� �`,-4�rc.k 2�J—y6r'-��6�' <br /> R�� � 4+'� ���i�;r� ADDRESS�yV SPfO�.(d r CITV2IP PMONE <br /> CONTRAC rc� � , TSCoo9Iq�jY Zl'3-yi�4••�0<. <br /> CONTR.LICENSEN R�E(,'J�p��h� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other �o/i�� <br /> WORK DESCRIPTION <br /> 1��f�!l nc�v rc5��ye��k�( cc��� i� QI<c� o�f- Crc;S�i,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE OF FIxTURE OR ITEM <br /> Toilet _ A/C-airhandlingunits <br /> Balhlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Cloth�s washer _ Clothes dryer <br /> Water heater _ Range hood <br /> i Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain � Boiler <br /> Floor drain � Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOI;AL SALES TN(CODE IS 9105 <br /> I hereby cerilify thal I havo read and examined lliis application and know lhe same to be true and coiracl. All provisions of laws and <br /> ordinaces governing lhis type of work will be compiied wilh whelher specified herein or not.The grantiny of a pertnit does not presume <br /> to give a�lhorily lo violate or cancei lhe provision of any olher slato or local law regulating construclion or lho pertormance of <br /> conslruclion.Thal I am�� 'horized by;he owner of lhis property to perform the work for which applicalion is made and I comply with lhe <br /> Slate Contracl�Law�"'�?G�W and 296.200 WAC. <br /> �" � - -- - � -ZG-p� <br /> ignature o wnedConlractodAuthonzed Agent Date <br />