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P��MIT APPLICATI�N <br /> CITY nF EVERETT PERMIT SERVICES <br /> 32�?�CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> A�PLICATIONS 1RE AC�ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS 'Z%J �j Ca}y/NU PARCEL TAX I.D.tl PE IT/ <br /> �V�retF- WA 9�028 � � <br /> LEGA LOiNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE53 CITY2IP PHONE�� �p�3S z <br /> J <br /> W�YNE �U�NG� L �f2S �oti�n��� AvE N S��-nz� w� 9d'lD9 <br /> TENANT NAME CONT.00T FOR PERMIT PHONE <br /> F-10 � T i�n� N- I � o n) G- M/}c` �2ati� 22d'•-6�3�{- <br /> CONTRACTOR AUOP.ESS CITY2IP PHONE <br /> P,qaF�c sic.�✓ EF�=�=?�2 yy� s �"'� ifvE w LyNNU�ooD W7F 9d'o <br /> CONTR.LICEN6E N <br /> PAC�Fs� 96S' CK � 2aG� �9�-39� q <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> E�ecMc Ges Other Z��m� <br /> WORK DESCRIPTION <br /> �'O v���r��+,/� 4 30�� � ��{� ryhef�� C�t�;1�r `�,��� �0x <br /> (t��4c�rwl/�- Cr'f w�`tf� �ex ct n `�c.� . <br /> PLUMBING MECHANICAL <br /> N0, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tailet FVC—alr handllnp units <br /> Bathtub Forced air systema <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kilchen sink 8 disposal Gas flreplace <br /> _ Dishwasher Gas renge <br /> _ Clothes washer Ciothea dryer <br /> _ Laundry trey Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ BackBow preventer Heat pump <br /> Urinal Unit heater <br /> Dnnking FounWin loiler <br /> _ Floor drain Refrigeratlon <br /> _ Grease trap 'Noodstove <br /> Roo(drains i'�'1?er <br /> Other �—'� <br /> i —I <br /> i <br /> CITY OF EVERETT LOCAL SAlE3 TAX COOE IS]105 <br /> i <br /> ��� I hereby ceritily that I have read anA examined this applicatlon and know the same lo be Lve and corted. A!I provlslona of lawa and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not. i�e pranting,r a permit does not presume <br /> � to gwe authonty to violate or cancel the provision of any other state or local law regulaling cc�istrucuon or the perfortnance of <br /> construction. That I am authorized by the owner of this property to peAorm lhe work for whioh appl(catlon is meda and I wmply wdh the <br /> S Contractors Law 18.27 RCW and 296.200 WAC. <br /> �,�,2.--(' __ 1�'I��, <br /> ISignature o wnen onlractor/Authonzed gent ate �j/\ <br /> I J <br />