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I PERMIT APPLICATION <br /> CITY OF EVERET�' PERMiT SERVICES <br /> I 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810-FlVC 425-257-8857-www.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE APDRESS PARCEL TAX�.D.tt P R�f IIT# <br /> l3o s � �� rt�\ Wa. � _ � <br /> LEGAL LOTNO. OLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> lS�Qa�I-4yo�,GA �999, �5a- o� <br /> 5"f'Co/Q�aS�' Co�n �O �0�111 $W l���i�1 rJ�"� Sr }'� .200 9��li� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ���v cna �t{i,r�_ �L 5 �y���eraP�s - An�ar �r�ar,�;a'1 �o� 3�-��tJ <br /> CONTRA TOR AODRESS CITY/ZIP PH NE <br /> �lre�gar CorPorcr�Qn ��iao �bsl�,� f�uy A-ioa �36�� 3E6—`��� <br /> CONTR.LICENSE# <br /> AN4GAL� 19/oa �„�al WA 9$a � D <br /> USE OF BUILpING HEAT SOURCE CONTRqCT PRICE O WORK <br /> ��'q,' . ,Electrk _Gas_Othat I � �J� ( � 3.`— <br /> WORK OESCRIPTION <br /> RovoJ��-�,n ana �h'�� p�um`1��noJ �or �es�' Quy, Ro�:�h-�n �'cor �'a4-w2. �'r. <br /> C�.�����6 0��1 O a 1 <br /> PLUMBING . MECHANIGAL <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTUFiE OR ITEM <br /> � Toiiet AIC—airhan411ngunits <br /> Bathtub Forced air Systems <br /> � Lavatory(wash basin) ,� Gas piping <br /> Showar � Waterheater <br /> �J_ Kilchen sink�BrelispeseF Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer ^ Ciothes dryer <br /> laundry tray Range hood <br /> 'a, Sink(service/bar/mop/etc.) T Exhaust fan <br /> BackBow preventer ` Heal pump <br /> 1 Urinal Unitheater <br /> 1 Drinking Fountain 6oiler <br /> ,� Floor drain ReGigeraUon <br /> 1 Grease trap Wwdshrve <br /> � Roat d2ins � C 1 � ' Othet <br /> ,� Other_ 1�12 p� UnAP.rqfour�l F�r�ng �o�� <br /> — �' ��s4'�r� �2• — <br /> CITY OF EVERETf'LOCAL SALES 7AX EOOE IS 3105 <br /> I hereby ceriUry that I have read and examined this application and know the same lo be true and corred. Ali provisions of lews and <br /> ordinacee goveming this type o(Work will bo Compllecl with whefher specified herein or not.The g2n�ing of a pe(mil does not presume <br /> to glve authonty to violate or cencei the provision oi any olher sWte or iocal law regulating wnsinidion ar the pedormance of <br /> consttuciion.That I am aulRorized by the owner o(this property to peAorm ihe work tor whiUi appliwGon is made and I comply wifh the <br /> State Contradors Law 1827 RCW and 296200 WAC. <br /> �Y..� �— y/�s/as <br /> Signat o on0ador/Author¢eU Agent � <br /> - : ;_:i�r ' :', _: ''". .9: dd�� cNc'uW'.' iV'iG � � ll 9��i ' �c'' ��y <br />