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PEKN�lT APPLICATIOtv <br /> CITY OF EVERETT PERMIT SERVICES � � ��`07 <br /> 3200 CEDAR STREET, EVERETT,WA 98201 ,�_ : 1;J <br /> � 425-257-8810-FA%<425-257-8857 -Nnvw.evereltwa.org ���� �i�� "`- I <br /> .� �r i <br /> �`n= J'� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM b�� <br /> SITE ADORESS ' �� �'� PARCEL TAX I.D.# �ERMIT# <br /> -#� o Ar. �'�-c,- 0�q-3�d3�tioi►n� � 0(Dll '� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. I I —I�. ?j'� g P�-QT �'r �U��� 1A}�liS1t7N �j <br /> OWNER ADDRE55 CITfIZIP PHONE <br /> K�WV� L1,C. �bo4 Z'�� 5`' N� Aiz��:�a G�2Z3 �3bo� 4o3-�u7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> /JON� ��n� �` N����S Zo6- h�q - ��3?i <br /> CONTRACTOR �'{�COtJ TNC- ADDR,ElSS CINIZIP PHONE <br /> `,� �F�o V�n,-�teL�/J��. C'�tvtlA�up j�.ZS-�J-l5�iZ <br /> CONTR.LICENSE#�4�,vY�'q17(�1, 1'SL�v� <br /> q�Z82 <br /> USE OF BU14DING , / HEAT SOURCE CONTRACT PRICE OF WORK <br /> Ml.i�� � unl�t, j� � ia� �� <br /> ���--�.,��L � 1.N�' i _Electric �Gas_Olher �705� (7f�U <br /> WORI<DESCRIPTION (�,�� �,sre�t�c�� -�p cow,���'. �'re�cru��-+- �u+W oF Z <br /> �U�Lr%'cs INCl.4DiNCn: �nZv�.a.i7 wo�K� UTi��%t� }ka�'K/'�� �pUN>A-TIo•U , `(Zhw„�1 ���'�� <br /> 1NEC.tIAn7��qti P(.uwR�n.(o� �CCY�.�Cht � lvSuvl-Ti�c, IuS�J��J4T�j�>r �niiSla � LA�uDsC+Ke <br /> ftvo A�u/ �i++'c/� �o�fS�e��c£S 'fD C��t+P��nov Ati7 hunt 1usP'r���N. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toi!et A/C–air handling units <br /> Balhtub „2 Forced air systems <br /> (�i Lavatory(wash oasin} (p Gas piping <br /> Shower ,2 Walerheater <br /> � Kitchen sink&disposal 02 Gas fireplace <br /> ,2� Dishwasher Gas rang� <br /> �2 Clolhes washer �� Clolhes dryer <br /> Waler healer �2 Range hood <br /> Sink(service/badmop/elc.) � Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinai Unit healer <br /> Drinkinc�Pounlain Boiler <br /> Floordrain � Refri�eralion <br /> Grease lrap Woodstove <br /> � Roof drains � Other 61��–ZA��t <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 31U5 <br /> I hereby cerilify Ihat I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces governing lhis type o(work will be wmplied wilh whelher specified herein or no(.Th2 grantinc�o(a pem:il does nol presume <br /> lo give aulhonty b violate or cancel the provision of any olher state or local Iaw regulating conslmction or lho peAormance of <br /> conslmclion.Ths t I am aul rized by iho owner oF Ihis property to peAorm lhe work(or which application is made and I comply wilh the <br /> Slate Con ocs�Law 7 RCW and 296.200 WAC. <br /> '`�� �11�z� � <br /> Signat re of Owned Nraclor/Aulhonzed Agent D te �' <br /> v <br />