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� PrRN11T APPLIrATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA P8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED fROM B AM TO 4 PM <br /> SITE AUDRESS "� " `-�� PARCEL TAX I.D.# PERMIT p <br /> �_'. i �6�t S-1 C�i1SrN<7 �' l, ����(�l� ^UU t <br /> �.EGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER A�DRESS CITY2IP PHONE <br /> �� �� /N(� <br /> TENANT NAME CONTACT FOR PERMIT PHONE q t f-9� �- i 99z <br /> ri1 //t/C) /�'�� � ��/�5�'I�l�"��� E•MAIL �//.f�i.11UJll�n�a{�G��t�c�79 �C�>H'7 <br /> c>4Y�A�ciiir��� l'�FISTA'U(lIJM1/ NM�fN� iN/ A66k�€ �II� P <br /> '1/75 /G��� A�t s.uTH <'Jb - 4bt -�7/l� <br /> CONTR.LICENSE N Sc.i iT-��YVA <br /> n,��� �irc, i�;��� a�w� a,5�ioa� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WOR.K <br /> /`"` �- '��� �� t9eclric Gas Other ��� �� `�`'��� <br /> WORK DESCRIPTION <br /> (�,,p,�; 1/2UCT l��'�- SNL i� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilc� A/C -air handling unils <br /> ---- p�p����y ForceA air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Wator heater <br /> Kilchen sink 8 disposal Gas lireplace <br /> Dishwashcr Gas renye <br /> Clothes w�sher Clothas dryer <br /> Walen c�ater Range hood <br /> Sink(service/barlmop/olc.l Exhaust lan <br /> Backllow r,reventer Heat pump <br /> Urinrl Unit heater <br /> Drinkiny Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Greaso lrap _ Woodstove <br /> Rool drains _ Other _ <br /> Other _- <br />� — — _—�----- — I <br /> CITY OF EVERE?T IOCAL SALES TA%CODE IS J105 <br /> I herehy ceritity thal I have read and examined Ihis applicalirn and know the same lo be true and conect. All provisions o(laws and <br /> ordinaces govr.rning lhis lype ol work will be complied wilh whe�her spocified herein or no�.The granting of a permi�does nol presume <br /> to yiv��,authority to violale or cancel ihe provision of any olher state or local law regulaling consl�uclion or the peAormance ol <br /> conslruclion. 1 hal I arn authorizeo by the owner of this property lo perlorm Ihe work for which applicalion is made and I wmply vtlth the <br /> Slato Conlrar.tors Law 1A27 RCW and 29G.200 WAC. <br /> � I t, � �hi,��i �;l; � 1i' _ �J .!il� i��' <br /> Siyn�Wro of OwnedContractorlAulhorized Ac�enl Dale �/Z <br /> �_ _ , r <br />