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P�r2MIT APPLICATION � <br /> CITY 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 FRCM 8 AM TO 4 PM - DEBIT& CREDIT CARD5 ARE NOT ACCEPTED <br /> SITE ADDRESS ��"�"Tk�£ Pn rwE�s pqRCEL TAX I.n.# PERMIT# <br /> 3 77� g2og.DwP,y � 1 (�'o� - � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �A��RESS CITY2IP PHONE <br /> �jl�MuT NOLDI�VCf�' �f2.S- Z(Z- 221C� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> NGn�rrr��c� rAQrtiErZS fZ0i1.] li �r-tPHR �`( 360 - 7Y�<- 7306 <br /> G�tNI� � �T <br /> CONTRACTOR �'j- S l�f E�'r'i N C. �v ADDRE55 CITY2IP PHONE <br /> S�a E�ssr Har� I-i�urto� 3�o -�'i4•-73�6 <br /> CONTR.LICENSE il 9 g L�Z <br /> � 5 hIEA c.$ t47JD <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ►-i r:=� ��a � � � <br /> �Electric Gas_Other 'Z s ��j0 <br /> I <br /> WORK DESCRIPTION <br /> IraSr�� Ar1Z D�ST�t16Unoti pu�-r woz.K (f-e��ES <br /> RND DtFFUS�s Fo� (V) E�c�SriWU S P�tT Mc.qr PUnv � s YST.FI�S. <br /> 1�15T�—�— C7) G}LHAuST F�1� S, r�/STg�—� I� TME�MDSTA�S <br /> A�� EpurPttEn� r w'tL PF�1"�►i i. <br /> PLUMBING MECHANICAL <br /> NO. 1YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub �_ Forcad air systems rF c�U t P• B Y O T��'Ee S <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> i _ Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> _ Other � p�,r �..� o��i-�It � F , D�FFuSE1ZS <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examired this application and know the same to be true and correct. All pro��isions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhonty to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made 2nd I comply w+:h the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> I �;-. L/,.-�e.a- 8- 2 -� C7�p � <br /> ' S'ignature of OwnenGtintractor/A onzetl Agent Date � L <br />