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I <br /> F'��RMIT AF�PLICATII,N <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 <br /> S�TE ADDRESS PARCEL TAX I.D.M PERMIT k <br /> I �: I �1�� hn ,t .St. _ � .) ' U��- I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS SC�1'21P/ PHONE <br /> (� Zo <br /> .�a �"':r�s ��n� It�i 4 C!+[s� nr.. St �W��r'C � �l2.Jr• 8 >� —67y? <br /> TENANT NAMt� I CONTACT FOR PERMIT PHONE <br /> �<x:.v� C—.J s w,�c ��2 C fS'7 c,. - (��7 53 <br /> CONTRACTOR ADDRE33 CITY2IP PHONE <br /> �C� _� G�MP.� �IL�AtV� <br /> 4u�.S' W. Ivt✓.�-Q1J41 C.iK� n/. <br /> CONTR�LICENSEp 3y,o�o�,5ti W � ��ZY`� 3�_� � 54 $ O14� <br /> KAI.Y�'1L H �c�G�(, P� ' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Elactric �Gas_Other I �y c�1. � <br /> WnPY.DE3CRIPTION <br /> In�+c�l •: -�<t. '�frnc�,Ls Sa � c�...r. � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet AIC-alrhandlingunits <br /> Ballitub Forcod alr systems <br /> La�•atory(wash basin) Gas plping <br /> Shower Water heatar <br /> _ Kitchan sink 8 disposal Gas freplace <br /> _ Dishwashar Gas range <br /> _ Clolhes washor Clothes dryer <br /> Laundry tray Range hood <br /> Sink(s�rvico/badmop/etc.) Exhausl fan <br /> _ Backliow prevanter Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boller <br /> Floor drain Refrigeration <br /> Groase Irap Woodslovo <br /> Roof drains Other <br /> = Olhar I � C��,� r(+, ...���ti4,r <br /> CITY OF EVERETT LOCAL 9ALES TN(CODE IS 3105 <br /> I horeby coritify that I have read and examined this application and know Iha same lo be true and cortsct. All provlsions of laws end <br /> ordinaces governing lhis typo ol work will be complied with whelher specilied herein or nol.The granting of a permit does not preaume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulating wnsWctlon or lye performaoce of <br /> r.onstruction. Th2l I am authorized by the owner ol lhls property lo perlorm lhe work for which eppllcalion is made and I comply with lho <br /> State Coniraclors Law 18.27 RCW and 296.200 WAC. <br /> ��,-n �t._ #'h / �� S�a ke,C`_ I i � �ti •G J' <br /> Signaturo ol Own Coniractor/A orized Agent ' Date <br />