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{ <br /> P: .RMIT APPLICATIC .J ��-�� -�s <br /> CITY 4F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-8810— FA,: 425-257-8857 —avww.everettwa.crg <br /> i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS pqRCFL TAX I.D. # PERMIT# I <br /> �n2� s F evt. f�� �!�- � l� osr'8 003 c�a9 oa " nSv6- 0� <br /> , <br /> LEGAL LOT NO. BIOCK TRACT <br /> DESC.� <br /> OWNER Ap�RESS CITY/ZIP PI10NE <br /> zac u�-�-Li3 9�2Sb <br /> 1�.�1r�r- /� 5-Tri� S U�/� 13i2 � Kkes�.�.� ,9r . G�h 5����..r L/ <br /> I TENANT NAME I CONTACT FOR PERMIT PFiONE <br /> � _,�e.v-vy 3�o�N.1�Dri 2�C -YN9-� 396 <br /> ' CONTRACTOR ADDRESS CITY2IP PHONE <br /> ' OCwI���/S ��Pw. S?4r C...-.'J' �.»/ J .Z/271`S?. .$'� .stJ•(pm�3�s �t/u �zG-Y`JY-�396 <br /> I CONTR.LICENSE# <br /> Oe.v.ryS G2�3 .v�` _ <br /> USE OF BUILDING hEAT SOURCE CONTRACT PRICE OF WORK <br /> Sr �.S /r F<ro-iy S•� cs/:�.r d, <br /> X Electric �Gas_OtY:er s" 6 S">/< o <br /> osr6�-.•,.-7'�</ _ lOSpOo. <br /> WORK DESCRIPTION <br /> �7 <br /> �, ;:, 1!'.J /J�'.�' .� <br /> �� - <br /> PLUMBING t�?«HA�JICraL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Z Toilet A/C-airhandling units <br /> / BathWb Forced air systems <br /> 2 L„�atory(�.vash 6asin) _j V Gas pipim� — r" - �s"6 c( F�d a 13 C� � <br /> % Shower j� Water healer t/r f <br /> �_ Kitchen sink&disposal i v Gas fireplace <br /> � Dishwasher � ✓ Gas range I <br /> / Clothes washer / ✓ Clothes dryer <br /> _ Laundry tray � ✓ Range hood i <br /> . Sink(service/bar/mop/etc.) Z � Exhaust fan �, <br /> ' _ / Backflow preventer Heat pump <br /> ._ Urinal 1� Unitheater oN�* �-y ° 13n.ie 6oai� I <br /> ____ Drinking Fountain _ Boiler I <br /> ___ Floor drain Re(rigeration <br /> Grease trap Woodsteve <br /> / _ Roof drains Other <br /> Other — <br /> — — I <br /> I <br /> � <br /> CITY OF EVERETT LOCAL SALES T!U CODE IS�105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and wrtect. All provisions of laws and <br /> ordinaces governing this rype of work will be complied�vith whether specified herein or noL The granting of a permit does not presume <br /> to give authonty to violale or cancel the provision of any other state or local la�v regulating censtruction or the performance o( <br /> construction.That I am authorized by the owner of lhis pmperty to perfortn the tivork for which application Is made and I comply with the � _ <br /> State Coniractors Law 78.27 RCW and 296.200 WAC. � <br /> ��.�� �_ �,�.� �e '++,/ 6���s <br /> Signature o Ovrneri`� t ctor/Authonzed A ent Date <br /> I <br /> � <br /> — i <br />