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'y; <br /> PErtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR ST. REET, EVERETT, VJA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 2 — 1 5 —O� <br /> SITF ADDRESS PAR(:EL TAX I.D.# PERMIT# <br /> ��'D7 Cm�:6rK 2So� -oa -o -oo o��-z-v� > <br /> LEGAL LOTNO. BLOCK TRACT �QC� r� <br /> DESC. " � <br /> OWNER ADDRESS CITYRIP PHOhE <br /> L ���4 8�D7 Covb�� Dr �v� u��� <br /> �.���1��' PHONE <br /> TENANTNAME . CONTACTFORPERMIT <br /> s�,�e. � J�� C�u(���s �`�.z�) zig -yvz � <br /> CONTRACTOR �1Qr.��p,e�p blcP �{�C ADDRESS CITY2IP PHONE <br /> � / $9zo z�fGA��e N.W. sfa��woa1 �o•�5y-9s76 <br /> CONTR.LICEtJSE p <br /> USE OF BUILDING , , � � NEAT SOURCE CONTRACT PRICE OF WORK <br /> n' I 00 <br /> (�rs�����CQ� 5t�t� I°Lrt'u+^-+TM _Electric _Gas_Other �� � �� XXX <br /> WORK DESCRIPTION �: ���I� a�r� y1i 5 �a e ,� �t <br /> \ C rv,v✓f �'�4<� <br /> `�j' o'���( ��l� c;�erl �5�� avey 1 S�� Q a '� �/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ �C—air handling unils <br /> BathWb _ Forced air systems <br /> Lavatory(v,ash basin) _ Gas piping <br /> W ater hea!er <br /> _ Shower Gas fireplace <br /> _ Kitchen sink 8 disposal Gas range <br /> _ Dishwasher Clolhes dryer <br /> _ Clothes vrasher Range hood <br /> _ Walerhealer Exhauslfan <br /> _ Sink(service/bar/mop/elcJ Heal pump <br /> Back�low prevenler Unit heater <br /> _ Urinal Boiler <br /> _ Drinking Founlain Refrigerelion <br /> Floor drain Woodslove <br /> Grease trap Other <br /> Roof drains — <br /> Olher — <br /> CITY OF EVE(tcTT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application and know the same to bo true and correcL All provisions of laws and <br /> ordinaces c�oveming lhis lypo ot work will be complied with whether specified herein or noL The c�ranting of a permit does nol presume <br /> lo give aulhoriry lo violate or cancel lhe provision of any other stale or local law regulating conslruction or lhe performance of <br /> construclion.That I am aulhorized by the owner o(this properly to pertorm lhe work for which appGcation is made and I comply with the <br /> �t te Contracto s La 18.27 RCW and 296.^<00 WAC. <br /> � •• � ����� � Date <br /> $Ip a ure of w � on raclorlAulhonzed Agent <br /> � <br />