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:� � ' � '�U -LS � <br /> PERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SEF2VICES <br /> 3200 CEDAR STREET, EVERETT, 'NA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTEJ FROM 8 AM TO 4 PM <br /> �L,�_�! <br /> SITE ADDRESS �� PARCEL TAX I.D.# PERMIT# <br /> fOiZTSCGVGRET'PMALLWAY, I3LDG�' j`'� hOS(2-��U% <br /> LEGAL LOT NO. P�O�K TRACT <br /> DESC. I <br /> OWNER ADORESS CITYIZIP PHONE <br /> M rn coNs�iiucrioN <br /> TENtiNTNAME CONTACTFORPERMIT PHONE <br /> KFN R0131NSON-GI M41 IP (i60)403-7462 <br /> CONTRACTOR ADDRESS qTYlZIP PHONE <br /> ItOl31NSON PI.UNI3WG WC. ?9330 124'flI AVF_N.�. AKLING"I'ON 98223 (36U)403-74G2 <br /> cor+rRucer+ses RO-f31-NP-`27?C2 <br /> USE OF BUILDING I HEAT SOURCE I CONTRAC7 PRICE OF WORK <br /> SINGLG I'AMILY RLSIDGNCIi _Eledric _Gas_Ofher �?p�5 <br /> WORK DESCRIPTION <br /> iNS'I'ALL PIRB SPRWKI.ER SYS"1'LM IN NI:N SPR <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITE��I NO. TYPE OF FIXTURE OR ITEM <br /> 7oi�e� AlC-air handling units <br /> Bathtub Porced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Ploor drain Refngeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other _ <br /> _I -�1 -�:1.L'Ji-4!I'.All> <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify ihat I have read and examined ihis applica�ion and know the same lo be true and corred. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether specifed harein or not.The granting of a permit does not presume <br /> ro give authoriry ro vioiate or cancel the provisien ot any other state or loral law regulating construction ur the pedormance of <br /> construction.That I am authorized by the owner of ihis property to pertorm ihe v+ork tor which applica;ion is made and I wmply with the <br /> Stale Coniracto LawI n18.27 RCW and 296200 WAC. <br /> �� V/ `'�[/ I 2���0 C <br /> Signature of Owner/Contredor/Authonzed Agent Date �� <br /> ( �/r ; <br /> - --- - , -- <br />