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-- --- � _ - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <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 �� ..1��v <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT M <br /> 3ne�niy Fu�,ri7cin�F s1e<<- �zo p1r �� -CX�J <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVI910N M <br /> DESC. <br /> OVYNER ADDRESS CITY/T.IP PHONE <br /> doCiN� Fv6RFT7 Fn� wTy 'Sv�; iv• ci}sitio 2P lEvG2G'17 98 zo3 <br /> TENANT NAME I CONTACT FOR PERMIi PHONE qzT-zoq_�y�Tq <br /> Df1�✓/RC. MA E•MAIL �an;.I/�+ � i�✓+��'•��.�.N, <br /> �b� <br /> 5Nln�N �-tCCHrwic �)(, l8?oZ yu'�/��E's . �Cn�* 9?Io1L A2S- Z03-9��-b <br /> CONTR.LICENSE N <br /> SH�Nu1�12 Ol .'� (��' - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /N/}NuF�{�-1ud�N�; _Electdc _Gas_Other �$�UJ r� , pp <br /> WORK DESCR�PTION <br /> yti57A« Ti�� c�n+firF�se�� k�K �k� q-lcr� UfILlTY ST��io�+�S� nrvD [iNGitl.�Niy <br /> [--rt I�'ASII /SH4l4iR. I✓ 17H wA>cn r+�n�rrit, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toilet AIC--eir hendling unita <br /> Dathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Wa�er healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> � Water heater _ Range hood <br /> Sink (service/6ar/mop/elc.) _ Exhaus�tan <br /> 1 Backllow preven�er _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Doiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Other _ <br /> �- Other u1�r rT s i� � � _ <br /> _i. ���L �l ot_) L — _ <br /> CITY OF EVERETT LOCAL SALES TA%CODE 19 3106 <br /> I I hereby r.ertily that I have read end ezamined this application and know Ihe seme l0 6e true and correct. All provisions of laws end <br /> ordinances governing ihis lype ol work will be complied wi�h whether specifed herein ar not. The grenting of e permil does not presume <br /> to grve authority to violate or cancel ihe provision of any other state or local law regulating conslruclion or Ihe perlormence ol <br /> construction. That I am authorized by the owner ol this property to perlorm the work for which epplication is mado and I wmply with the <br /> Slale Cont�e tors Low 18.27 RCW and 296.100 WAC. <br /> ,,.., �� II/4IlD <br /> Sign ure o1 OwnedContr2c1ar/Authorized Agenl Date <br />