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PERMIT APPLICATION <br /> CITY OF EVERETT PFRMIT SERVICES � � _ �$ —0 6 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROPdI 8 AM TO 4 Ph1 !`` // r� } <br /> SITE ADDRESS PARCEL THX I.D.p PERMIT# <br /> � '�.t'S__4=��— <br /> �L- j t b�t.'��Tr i�''],a l! b�f;�SC <br /> LEGAL LOTNO. BLOCK 7RACT <br /> DESC. <br /> _ .. _. .-- - - -- <br /> OWNER <br /> - _ ADDRESS . _. .. qTYZP ___ . PHO . . __ .___ <br /> �Fe2 �o SHtli �Y ��•i ; r <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> qA°ih � w l'���c ', � T���� C�cr�PE� ��'6. �z9. 5��its"' <br /> CONTRACTOR (; � S�"STF�'1S ADDRESS „v CITY/ZIP PHONE <br /> � � 2�-�. n,'t i7> ACii�ic�L/ �125 �i� z •L' ' �`� <br /> `l� G'2 � <br /> CONTR.LICENSEB� /���-S� Q���� <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF YYORK <br /> �ElecUic �< Gas_Other �7�li'�� <br /> ('c�nti�l�� �,n� <br /> WORKDESCRIPTION �Ze1eC.�ITL �-,¢��� �,���r,t5�,�5 � �ti����Nv �,C,' //S /��'•< <br /> �l��f"���N� . Kc l��c�arL (�� 7-��l�T <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM <br /> NO. NPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) ,__ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> — Rangehood <br /> Laundry trey Exhaust fan <br /> _ Sink(servicelbadmopletc.) — Heatpunp <br /> Backflow preverler Unit healer <br /> ,_ Urinal goiler <br /> _ Drinking Fountain Refigeration <br /> _ Floor drain — y�p�s;ove� <br /> _ Greasetrap � p�er �-k D� F Ei� <br /> _ Roofdreins �q��A;;%.',., Sr�� <br /> Other — �T <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined lhis appliqGon and know the same to be We and corred All provisions oP laws and <br /> ordinaces goveming this type of worlc will be complied with whether speafied herein or noL The grantlng of a pemit does not presume <br /> to give authority to vioiat�or cancel the provision of any other state or lopl law regulating consWction or the performance of ���e <br /> construction.That I am authorized by ihe owner of this property to perform the work for which applica6on is made and I comply <br /> State Contradors Law 1827 RCW and 296.20D WAC. <br /> ��� �l 1, ��F-�?U"� ��l��1�U�'— <br /> Signature o!O dCo ctor/Aulhonzed Agent Date <br />