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I ___ _ _ _ .. _.__ _ __ . __ _ ._ _ _ . _ _ <br /> i PERMIT A�PLIC�4TION I <br /> I CITY t�F EVERETT PERMIT SERVICES 6 � <br /> 3200 CEDAR STRE�T, EVERETT. WA 98201 ' l -�� � <br /> I 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��T-J ��� <br /> I SITE ADDRESS � PARCEL TAX I.D.# P RMIT# <br /> �� ��� //-�`� �� �'�� �'`J ��OS I FSUG YO�fsv 0 �vG, �c � oo� <br /> LEGAL LOTNO. BLOCK TRACT <br /> � DFSG. <br /> OWNER : A�DRESS CINIZIP PHONE I <br /> � c ..� r '. ,"�,:! i ri.- _ I�% �� + I <br /> �,I `�est�'esr C'e„�i,�;es 9Y!-ys.t-o,00 <br /> �(3Y3 VDa! K�ar»+ta � NeW ��f Q�e� CA- Y'2GG0 <br /> I TENANTNAME CONTACfFORPERMIT � PHONE � <br /> �� 73(�!� 3 ske!( 1'4cka�e_ Cd�lvs T3Q,�s Yss—Yc� —/cy.f � <br /> I CONTRACTOR ADDRESS CINIZIP PHONE <br /> S .D. D�4roN �3�5 i3or� Ave A1E <br /> CONTR.LICENSE# y��Y y�� <br /> .SD���Cw ��rNr S�t a0U� g2��NuG�1✓f} /�.5 ��IK 4a5• a�'f••�+tnp <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� �2J5�1�1� �ui��i�S ��f4. � _Electric ✓as_Ot'�er ����,2 � �3 �O <br /> iWORK DESCRI�TION <br /> -�onSf�ucf+'e.�! � Q �I PJ skrl( 1?a��•�a . TS u��i =r�.,��e P��.F.f� Qa /�r� o/q/�° <br /> I / <br /> S�%� C -1 _ c.iL-- /�.t�� <,ti <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet ��C—air handlin� units <br /> Bathtub Forced air sysiems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas freptace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc) Exhaust fan <br /> Back(low preventer Heat pump <br /> Urinal Unit healer <br /> Drin!�ing Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> � Other <br /> IICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that f have read and examined ihis application and know lhe same to be true end correcL All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whether specifed herein or not The gran�ing of a permit does not presume <br /> to give autho�ity to violate or cancel the provision of any other state or loral law regulating construction or ihe perfomance of <br /> �onstruction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contractors Law 1827 RC1h'snd 296200 WAC. <br /> c��'��-'— b nG <br /> Sign e of OwnedContractorlAuthorized Agent Uate <br /> YZ <br />