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I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRcET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857 -www.everettwa.org <br /> �/� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS G�yt�F`IILj�T�G✓�C� PARCEL TAX I.D.# P�R IT#� <br /> _� w� - c� �� o0 9�s0000 � - �ln�C7D Z <br /> LEGAL LOT NO. BLOCK TRACT <br /> UESC. <br /> IOWNER ADDRESS CITYIZIP PHONL' <br /> i N'okqM� Klt�):r-�-11- � <br /> �n/iu�.�✓���0 3� �z�� S�/- �S <br /> 'I TENANTNAME CONTACiFORiERM1T PHONE �� <br /> lKo� I 3�ZZ�/E b�N6 ��6> G8� -s000 j <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> �Y�P�c Gc��c. �o,vi��n�3 �90A� -/Z. Ncw�7T'•rv�. / 2 I <br /> CONTR.LICENSEC OL��P�C ( �S�C [:✓E/`-�-[/, w�f C(J/�� C y�� J/�_D��l I <br /> USE OF BUILDING HEA7 SOURCE I CONTFACT PRICE OF WORK I <br /> ��-U(e�7`�� C/7 -2) I _Electric Gas_Olher �a,sQ �Q� <br /> / <br /> WORK DESCRIPTION - <br /> Tc��i- �rT�,�o��r�s G�- T,�ro�u�-r,o�-�vZ- /�a�� o� ��nr�+x� C��4iP� <br /> /�s7'rr✓Ht*'� qr .S'P�E �l lN ���cv�n/5 �3 A� E�/E�er3r (��i„�C'e�"1�+2I <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> Toile� A1C-air handling units <br /> Bathtub Forced air systems I <br /> � Lavatory(wash basin) Gas piping <br /> _ Shmver � Water heater <br /> Kitchen sink 8 disposal Gas freplace <br /> � Dishwasher / Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lrey � Range hood <br /> I � Sink(service/bar/mop/etc.) ,�j E�:haust fan <br /> Backflow preventer _ Heatpump I <br /> � Urinal Unit heater ' <br /> � Drinking Fountain Boiler I <br /> � Floor drain / Refrigeration <br /> � Grease trap Wcodstove <br /> � � Roof drains Other <br /> I _ Olher _ <br /> ICITY OF E\'ERETT LOCAL SAIES TAX CO�E IS 7105 <br /> I I hereby cerilify ihat I have read and examined lhis appticalion and know the same to be lrue and correct. All provisions o(laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> Ito give authority to violate or cancel the provision of any other slate or local law regulating construction or the per(ormance of <br /> construction.That I am authorized by the owner of this property to pedorm the work for which application is made and i comply with the <br /> State Coniractors Law 1827 RCW and 296200 WAC. <br /> iS�gnature of OwnerlContrectorlAuthonzed Agent Date �/ <br /> � Z <br />