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F �RMIT APPLIC,�►TI�N <br /> CI i Y OF EVERETT PERM+T SERVICES <br /> 3200 CED/,R 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 / <br /> PARCEL TAX I.D.� PERMIT# <br /> ���� LO��� �I�G - � <br /> LEGP LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS CITY2IF PHONE <br /> TE�ANT NAME CONTACT FOR PERMIT PHONE <br /> i�iih�,� ���rit.i� /�<<.,�,-� I ��o,�s �v� r�� /1ls-�fr3-9zZ/ <br /> CONTRACTOR i f 7,� � ! ADDRESS �� 3� �s��'�,��21P PHO/NE <br /> �}?�/i � e'Gl•(tin�%n - �L.�NK/n/!,! u� <br /> CONTR.LICENSEp � C ��T�Jl/� g C h� i/t,r�y3—y« <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eicctric �Gas_Other �QQ d <br /> • K,t,., rc., �.L — <br /> WORK DESCR�IJPTI N � s. <br /> Gc�`�� � �r�r /�tu<on�t�,f ,l�✓a.s+�.y.� /C��� /�'r <br /> T7 Y'"n�C' 'C.�'s�+•f`; /'anT [/lPtf'S 7'!�n-� �Ci'C L.. 'JA+����'^ . <br /> � MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OA.ITEM <br /> Toilet _ �C–air handling unils <br /> BaOilub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Waler healer <br /> _ Shower Gas flreplace <br /> _ Kitchen sink&disposal — Gas rengo <br /> _ Oi�hwasher Clolhes dryer <br /> Clothes washer — Range hood <br /> _ Laundry tray — Exhausl fan <br /> _ Sink(s�rvicelbar/mop/elc.) Heal pump <br /> Backflow prevenler — Unit hoaler <br /> _ Urinal Boiler <br /> _ Drinking Fountain Retrigeration <br /> Fioor drain Woodslove <br /> _ Grease trap � Olher <br /> Roof drains <br /> Ol'ier _ �'r/t � d oA/� <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS Ti05 <br /> I hereby cerilify that i have read and oxamined lhis application and know lhe same lo be true and correcL All pmvisions of laws and <br /> ordinaces qoveming lhis type of work will be complied with whelher specified herein or nol Tho g�anting of a permil does not presume <br /> to give aulhonty to violate or cancel lhe provision o(any olher slate or local law regulaling construction or lhe performance of <br /> canstruction.That�am authorized by lho owner of this property lo perform lhe work tor.viiich aoplication is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> i - � ` 1�-�- OS <br /> Signalure o ned ctodAulhonzed Agent Dale �a <br />