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I�`RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—r'AX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT R CRERii CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.O.K PERMIT� <br /> `�!9 , Q ' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE33 CITY2IP PHONE <br /> Skel� �en� /�!� Col(� �✓r_ �� �'�l y.�5-33y-�iN� <br /> TENANT NAME I CONTACT FOR PERMIT � PNONE <br /> Sa�+C G;5 R�tJ✓C �rM{ r�s aErl✓C <br /> CONTRACTOR�niof SPlV�[�S of �c ��,;, �DRESS ��.5 Y4i'7 A�� � CITY2IP PHONE <br /> sr�o Muk.lfro v�s-��;s-.�aaz <br /> CONTR.LICENSE N ���7S <br /> SClJIo55av3O N <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S�nS(� ��.,,� (r Rcs�arntt Electric Gas Other 3�v� <br /> WORKDF.SCRIPTION R�mom fxb�a��•.y W�•f�^ h�c.�r� 1 KP�4,� w�+h ,5ome <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTVRE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink 8 dispose, Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes deyer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/elc.) Ezhaust fan <br /> Backilow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greaso trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SALES 7A%CODE IS J705 <br /> I hereby ceritify that I have read and examined this application and know lhe same W be true and wrrect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether speci(ied hereln or not.The granting o(a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaling conslruction or the pedortnance at <br /> conslruction.That I am authorized by lhe owner o(this property to perfortn the work for which application is made and I cnmply with the <br /> Slalo Conlrectors Law 18.27 RC and 296.200 WAC. <br /> (�r���� ar�o 3�cJs" <br /> sigrp �Li OwnedContraclodAuthorized Agenl Date <br /> 0 <br />