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------ — '_ ,`' °`�— <br /> PERMl1� APPLICATION �� <br /> CiTY OF EVERE i Z PERNfIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-�810– FAX 425-257-8857–vrnnv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> StTE AD7RESS q � PARCEL TAX I.D.# I PERMIT# � <br /> /,fLOU .��o � �i � U�d _ � X 4�0� - D 3 <br /> LFGi� LOTNO. BLOCK TRACT <br /> �`5�: 971 Z Y <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �� �� N a�,` 66.� ,���G ,d �« ���1�v� s�3 s�s-o�y <br /> TENANTNG�e� � �; �'Q �O � I ��� �vRPE�ITK� PHONE <br /> ry� � <br /> CONTRACTOR ADDRESS . CITYIZIP PHaNE � <br /> �/l t�hol� l��h�' z33/� �v� �..�1-��1�'�•, k�-( �r�2 ��,, .r��o. y�r�'b',� �ao) <br /> ONTR.LICENSE# <br /> �LG /�N 0.�(0,� rto 91.�1',S-3 <br /> USE OF BUILDING hi[AT SOURCE CONTRACT PRICE OF WORK <br /> _ I `Elec!ric _Gas_Other �7�� ' <br /> WORK DESCRIPTION <br /> ��ti�, ,� ��., �� Nl� /Pa� .�r� G <br /> FLUMBING MECHANICAL <br /> � -N� TYPE OF FIXTURE OR ITEM NO. T'PE OF FIXTURE OR ITEM <br /> y_ Toilei _ M�.; -air handling units <br /> Bathtub Forced air systems <br /> I _Z :avatory�wash basin) Gas piping I <br /> , Shower � Waterheater <br /> �; 1_ Kitchen sink 8 disposal Gas fireplace <br /> ' 6ishwasi;er Gas,�oge <br /> �, Clcthes wasi;er Clothes dryer <br /> ' Laundry tray Range hood <br /> � , _ Sink (service/badmop/ecc.) Exhaust fan � <br /> _ 8ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> � I Floor dr2in = Retrigeralion <br /> Grease trap Woodstove ; <br /> IRoof drains . = Other � <br /> � pt��W tiae � ��•`1 <br /> I — � <br /> i - - <br /> I CITY OF EVERETT LOCAL SALES 7F.X CODE IS 3105 <br /> � __ ___ j <br /> 'i I h�reby ceritily lhal I have read and examined lhis applicalion�n��no�v lhe same to��Uue and correct. All previsions of laefs and <br /> � c�^�naces goveming this type of work wi9 be conplied with whether :aecified herein or noi.The granting of a permit does not presume <br /> � to g�ve authority to violate or cancel the provision nf any other state or local law regulating cons;ruction or the performance of <br /> '� construction. That I am authorized by the owner of Ltiis property to perf rm the work for which applic.�tion is made and I compiy with the <br /> i Staie Co,�n cto s,Law 1827 RC ' and 296.200 WAC. <br /> ��' � 7 I� r� � <br /> �i,natu _ofOwne Co�cac�or/ u onzedAgent — . Date — --� <br /> I <br /> i <br />� I r- <br />