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�� PERMIT APPLICATI�nI q �� � �9 <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, �VA 98201 /� p <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org l/:J�j�O/S <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAl(I.D./f PEq+y,T,At,�� ` <br /> fv10 �; Cu51nv �o ///;[�y � <br /> LEGA LOT N0. BLOCK TRACT I �, <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 1,6A R�al�u �un�' LTI 11�1oi Vo(I KgrM�1'1 AvB Irv�ne Ca, `���� �i`� `�55 �i�r'i7 <br /> TENANT NAME CONTACT FOR PERMIT PH()NF. <br /> Vf'.I�IZGY1 ��li l.�el>5�clr_ .�oL� (�o� �i(o� <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> �Inctr�ct S�st�rns n�F�h • I`IooA���ar� �ly� So . � au2 .�.�a�lie �1Ssi3�l �UW �i33 1�03(� <br /> CONTR.LICENSE U N L�jC S IM ��� �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,Electdc _Gas_Other I f� '� �O �U <br /> � <br /> WORK DESCRIPTION <br /> Tn stall ot,e Y�r�.� c(uctleSs SQI�� S�M ��C un�t anc� �hvee <br /> ruoff-�� ���r in�t3ke hood5 t� C'x�s�in� d�5��b,.tt�o�n S�s`�m <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP F�XTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory (wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/elc.) Exhaust fan <br /> � Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greasa trap Woodstove <br /> Roof drains Other <br /> Other <br /> —I <br /> CITV OF EVERETT LOCAL SALES TAIf COOE IS 7103 <br /> I hereby cerilify that I have read anC examinetl this applicaUon ontl know the same ro be true and correct. All provieions of laws and <br /> ordinacos governing thrs type of work wdl be compl�ed with whether specified herem or not.Tho granttrg of a permit does not presume <br /> to grve authoriry to wolate or cancel the provisian of any other stale or local law regulaung construction or the performance of <br /> construction. That I am aulhonzed by tha owner of this property to perform the work for which application is mede and I comply with the <br /> State Contre tors Law 18.27.RC'JV nd 296.200 WAC. <br /> ��-'�-� �V152��(�C�v �� '�Cj Oq <br /> Signature o wn7�er�ntra rorAuihonzed Agent bate � <br /> I <br />