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PtRMIT APPLICATIUN <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 FROM 8 AM TO 4 PM � 2,, _� _ p'7 <br /> / <br /> SITEADDRESS L✓EK�TT PARCELTAXI.D.tI PERMIT# <br /> Si� ��. c�s,�C �'�� w'''p ,�Sc41 1cv5� '�II -U-a2 <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION M — <br /> OESC. <br /> OnWNER AUDRESS CITY/ZIP PNONE <br /> IJ++L�(3.(L S-rA(GH 1IIS_ I�L17NE �/�'�s��,itt �'�� �h271 �12f-t3t �r�-� <br /> TENANTNAME CONTACTFORPERMIT PHONE yZS_23z-�rsy <br /> 4�oLcq{ �,LtS S)�,E c. ir� SinrG.M E•MAIL S�NG a76 AI.��L. <br /> �bRiAAi: <br /> CONTR.L�CENSEN ��(,�,�.iE� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'[leclric _Gas_Olher � /ppa. � <br /> WORK DESCRIPTION <br /> / , / � <br /> IJ�^-1.�C�` 0. !�f l�c...a�-�(o l �n+�,� � fnc� i�. ,1.'ll4-�t ^^"� ��l Gl�.l(AR �ILS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Oathtub ForceA air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater hoaler <br /> Ki�chon sink 8 dis{�osal Gas lireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhos dryer <br /> Walor huater Rango hood <br /> Sink (service/badmop/�lc.) _ Exhausl lan <br /> Back�ow prevanter _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeration <br /> Grcaso trap _ Woodslove <br /> Roo�drains Olher <br /> Othor — <br /> CITY Of EVERETT LOCAL SALES TA%CODE 13�105 <br /> I hereby cerili�y tha�I havo.read and oxamined lhis applicalion and know ihe same to be true and correct. All provisions ol laws and <br /> ordinaces gocerninc�this type ol work will be complied wilh whether spocifiod herein or not.The granting of a permit does not presume <br /> to flive authorily to violate or cancel lhe provision of any othcr stato or local law regulaling consiruclion or Ihe pedormance ol <br /> construclion.That I am aulhorized by thc ownor ol this property to peAorm lhe work lor which applicaQon is made and I comply with Ihr <br /> Slato Contraclors Lavr 1627 RCW and 296.200 WAC. <br /> ��.,� // 20 oZ <br /> Signalure ol w dContrector/AuUiorizod Agent � ate <br /> �I y <br />