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Fr�RMIT APPLICATI�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 ACCLPTED FROM e AM TO 4 PM -DEBIT R CREDtT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.R PE T K <br /> % C' _6 d l: ooy3asRysD3ioa <br /> LEGA LOTNO. BLOCK TRACT ^ <br /> DESC. ��V� � � .C/�JT N�� <br /> OWNER ADD,•tESS CITY2IP PMONE <br /> �,o� ���v-Q�v.�,�y G.e�1.lFRsa.� i�az coLe�,r✓.�.trTr 'S'1�S �f'Z-WJ9 <br /> TENAN7 NAME I CONTACT FOR PERMI PMONE <br /> �'-��ua.F. 4'1S-��L-�/3 j' <br /> CONTRACTOR ADDRESS CITY2IP PMONE <br /> a�i••� J-�Poav�.»b.�.f �e,�r 6�z 2 lo�,g.y 1�`�, .YI.II✓st�i�/B 9827d .�O-L3'3-9)>/ <br /> CONTR.UCENSE N / <br /> .y M,�_ z'c .� o r v S q <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other 9 � — <br /> WORK DESCRIPTION <br /> �L.�r,� ✓- sr.qfR ,�-,o%�«��� �l°Y�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> Toilel A!G—air handling units <br /> _ Ba1hW\ Forchd air systems <br /> _ Lavatory(J�ash basin) Gas pi ' g <br /> Shower Walerhe r <br /> Kitchen sink 8 ' sal Gas fireplac <br /> Dishwasher Gas range <br /> _ Clothos washer Clothes dryer <br /> _ Laundry tray �\\\ Range hood <br /> _ Sink(service/badmop/etc.) \ — Exhaustfan <br /> _ BackOow preventer � Heat pump <br /> Urinat � Unit heater <br /> _ Drinking Fountain � Boiler <br /> _ Floor dra(n Refrigeration <br /> Grease lrap � � Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I hava read and examined this applicalion and know the same lo be true and wrrect. All provisions oi laws and <br /> ordinaces poveming lhis type of work will be compiied wilh whether specified herein or nol.The granting of a permit does nol presume <br /> to give aulhority to violate or rancel the provision o!any ather slate or local law regulaling construcUon or the perfomance oi <br /> construction.That I am authorized by the owner of this property to perfurtn the work for which applicadon is made and I comply with the <br /> Slate Cont/ctors Law 8.27 RCW and 296.200 WAC. <br /> ���-�7 �ii.�, r�'_ �6�3�D5� <br /> SignaWre of O r/Colt aclo�Authonzed Agent ' Date �/2 <br />