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( f <br /> PERI�IT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org �-�o��_�v2 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �D�O�J " �Oj <br /> SITE ADDRESS PARCEL TAX I.D.X PERMIT if - <br /> 3931 Fr In I`�ve . 004101po 05� Z <br /> LEGA LOTNO. BLOCK TRACTORSUBDIVISIONA <br /> DESC. �j oos D t-wi HEw��rr Hrc�GHrs AOO� TION <br /> OWNER ADDRESS CITY2IP PMONE c��-��ps� <br /> �`'1�chuF I � N1Gv ru �o,�a ��i',I F�- , r.lc� �, �V� Eve�� �I , (,bA �lR �n 1 <br /> TENANT NAME —� CONTACT FOR P MR PHONE i.�vr_ZS`1-(o OS � <br /> I Mic'hael ov N1o��ti �holuw; _c� <br /> E�a�Ma v iul�pin th <br /> CONTR.LICENSE p � �� � �/ R S �''%� -2 3�-4�✓�� <br /> M�r� p�Pfi <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> SU�L,�P �CI Wt��1, Y�s�'CJE1'1 C E Electric _Gas_Other � 15 � b o U . 0 0 <br /> WORK DESCRIPTION <br /> �x�av�� -I i�ig s .� ce �-o c� e<< l-e s -lo ►•�� c ��-{��lc� <br /> coNsi� E-�'t� 9 ,o� h.� w -(�ct Ya i �}ions �-o cYea�c� -I-I� Ye e <br /> S�oy4� {' cl Y"�US. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bath�ub Forced air systems <br /> avatory(wash basin) Gas piping <br /> er Water heater <br /> Kitchen ' 8 disposal s fireplace <br /> Dishwasher Ga nge <br /> Clothes washer Clothe er <br /> Water heater Range hoo <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> =I F�of drains = Other <br /> OL�er <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specilied herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision ol any other state or local law regulating construction or the performance of <br /> construction.That 1 am authorized by the owner ot this property to perlorm the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and�96.200 WAC. <br /> '��r c ,� �l�n.,w �`�I i_310 � <br /> Signa re ol Ovmer/ ont or/Authorized Agent � ate / <br /> Z <br />