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P�R��IIT 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 FROM 8 AM TO 4 PM <br /> SITE ADDRESS �� ' '' ' PARCEL TAX I.D.# PE MIT It <br /> �� OCi`3 ��l , �/'1 S ���r, �r' , <br /> I.EGAL LOT NO. OLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �n � � �� �, �/Uki•hAshima�v �J 6ot �ng . Com <br /> TENANT NAME {CONTACT FOR PERMIT PHONE <br /> ���� � ���� it r� s i+ ,r,,, o�-� �Y�z�)�r � = I`7 9 �- <br /> CONTRAC�T lJ r If �r..l� ADDRESS CITV2IP PHONE <br /> ` ' r n <br /> CONTR.LICENSE M ��OF.7��j��' ����A <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> ���- (�� (�� _ Eleclric _Gas__Olhcr ��-�(� �CC� <br /> WORK DESCRIPTION <br /> (l �)r /� �, ��) f- (' \ l i`�. 1� ir� ,'( <br /> r <br /> ------ ----- --- - --- - ------- - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilot A/C—air hendling unils <br /> Balhtub Forcad air sysloms <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Wa�ar hoator <br /> Kilchon sink 8 disposal _ Gas tireplace <br /> Dishwashor Gas rango <br /> Clolhes washer Clolhos dryor <br /> Walor heater Ranpo hood <br /> Sink (sorvice/bar/mop�r.tc.) _ Exhausl lan <br /> Bar.k(low prevenl�r _ Fleat pump <br /> Urinal Unit hoator <br /> Drinkiny Founlnin _ Boller <br /> Floor drain Refngerallon <br /> Grease Irap _ Woodslove <br /> Rool drains Othor . <br /> Olhcr <br /> CITY OF EVERETT IOCAI SALES TIUC COUE IS 3705 <br /> I howby ceritify ih�l I have read and examined�his applicalion enA know tho same to bo Irue and r.orcocL All provlslons of laws and <br /> ordinaces yoveminq lhis�ype of work will be complied wilh whother specified herein or not.The granling ol a pormil does not piesume <br /> �n c�iva aulhority tn violalc�or canr,el Ihe provisioa ot any olh�r s�ale or local law regulaling construclion or ihe perlormance of <br /> I construclion.7hat I am aulhorized by lho ownor ol lhis proparty to pe�torm Ihe work for which epplicalion is made and I comply wilh the <br /> Slnte Contradors Law 1Fl.27 RCW and 29G.200 WAC <br /> i - � <br /> �� /:. �. <� J� ; lr�i�� : ���:� �'�r���yo <br /> ISign�ture of OwnodConlractod�uthonzed Agent Oale <br /> i _ _ _ _---- ---- - /z <br />