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PERMIT 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 <br /> �� ., "�1-- /' � <br /> �� � � ��.j7� J�q� PLIC TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PEf�N11T,N _ � <br /> '��� �- -- i� �;r� ��'-�/ <br /> LC dAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER pUDRESS CITY2IP PHONE <br /> /IACl�oNht-�'S Cv2r� /o2zo NE �rai�1T5 t�[. K�,ziC�wnrl 98033 4zs. sz� 9�00 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �' /1�oA�r,l- l�qsnN�'Yt 3 bo- fr L 7. -B 3l L <br /> CONTRACTOR�o2y Tyn/C GON 7HsicTB![S ADDRESS CITY2IP PHONE <br /> /!�o ,�ir.l�{�rn� '�+�� �SNoHoM�s�� BfrO—&/.2—F3/G <br /> CONTR.LICENSE# ��Z9 d <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �+5�a✓✓u vi T _Electric _Gas_Olher — /(� DOO <br /> � <br /> WORK DESCRIPTION <br /> �rivi� S�f-a.-r �p � Q.DA coo(-ts <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tnilet NC—airhandlingunits <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Walcr hentar <br /> Kitchen sink&disposal Gas freplace <br /> _ Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> _ Sink(service/bar/moplelc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap Woodslove <br /> Root drains Other <br /> Oiher <br /> CITY OF EVERETT LOCAL SALES TAJ(COOE 151105 <br /> I hereby ceritity that I have reac and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The gran:ing of a permit does not presume <br /> to give authority to violate or cancel Ihe provision of any other stale or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner ot this property to perform the work for which application is made and I comply with the <br /> State Contractors L.iw 18.27 RCW and 296.200 WAC. <br /> 2�j S�D 6 <br /> � Signature of wner/ omractor/Authorized Agent — Dal � <br /> � <br />