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PERMIT APPLIi.ATIQN <br /> CITY OF E`JERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 9820 i <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _//_p 7 <br /> SITE ADDRESS PARCEL TAX I.D.# ERIy�� /_ , � <br /> �l-O!?1� EJ�Cp�J t�lA� o0 58 i H � �� � <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> (L eS+��K (,�c 15O E. 7`?siD ST2U f ����FKcnY <br /> 27r,} �=�00,2 NY IOOZZ <br /> TENANTNAME CONTACTFORPERMR PHONE <br /> 5'fADLES p0� ULV1+[� C�ZS� 337- 37�y <br /> CONTRACTOR 51E��A G�NrR��"� ADDRE55 _�� LO �,?E L� CITY2IP PHONE � <br /> �� <br /> F��No��, c�b� �as- a�ti <br /> Ni�-�aut- MnR�++ �3a suisF A �n qZ�9 <br /> CONTR.LICENSE R <br /> (,8 3z9 _ _l�o `� <br /> G[ASS 3 /�wlhCS' —1 t n O —1`-1 S �: <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> MC�CA-I�TL� �yEleclric _Gas_Other I,Y ��(� �J <br /> -� i <br /> WORK DESCRIPTION <br /> jLa+,ovy oF �x»'S�� 2N���G- N'f-W y'ol+:{?u� t Ew��w�'� iMSTM;-:11 'X-r�oUfiWJ O'= E74SSi�y <br /> �Nc<.�.a� �} NwW iv(t�o�-'Cb 1z��`t�.c��. N�u ��YAG 4 iu.t�.YR-�caL T{-P.aA.l�a( 6�k;Li,S SG:lcc_ <br /> 6JtiSf�.w soacc. 1D P� A�ocO BrT�.�e:.� s-C�.f�.t5 k Aru('EL �iiX13-CF�E � �-! C�OVL J�lDif 76�1��,M'� Gfi7i1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTLIRE OR ITEM NO. TYPE OF FIXTl1RE OR ITEM <br /> 3 Toilet � A/C-air handling units <br /> Dalhtub Forced air systems <br /> Z Lavatory(wash basin) > Gas piping <br /> Shower � Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas ranoz <br /> Clolhes washer Clot�es dryer <br /> Laundry lray R�nge hood <br /> �- Sink(service/bar/mop/elc.) � Extiaust fan <br /> Backflow prevenler _ Heal pump <br /> � Urinal Uriit heater <br /> Drinking Fountain _ Eoiler <br /> � Floor drain _ Retrigeretion <br /> Grease trap _ Woodstove <br /> Roof drains �� ;-�-ti Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and know the same lo be true and correct. All provisions ot laws and <br /> ordinaces goveming this ryne of work will be complied wilh whelher speci�ed herein or not The granting of a permit does nol presuTe <br /> to give authority to violate or cancel:he provision of any other stale or Iccai law regulaling construction or the pedormance of <br /> conslruclion.That I am authorized by the owner of lhis property to periorm tlte work for which application is made and I comply with the <br /> State Contra ors Law 18.27 RCW and 296.200 WAC. <br /> � f`'�r-� E�:� `��2��7 <br /> Signat re bf Ow e/Contractor/ horiz gent Date <br /> Y <br />