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I PERMIT �4PPLICATION <br /> ClTY OF EVERETT PERMlT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org �•Z--19 � D� <br /> APPLICP.TIQNS ARE i,C•CEPTED FRO"�i 8 AM TO 4 PM <br /> SITE ADQRESS PARCEL TAX I.D.# I PERMIT# <br /> �IL'ir� I��21�(V �D7�ICi � LC� � 2– Ul , <br /> LEGAL LOT NO. BLOCK TRACI'OR SUBDIVISION# — <br /> CE50. I � <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> Cl�a�( �+��rl Re�r�vJ Lech��d 4o3a K�rv�r Av� cv+�raJ �iBz�I ��IdS)a5�t -,�.�7� <br /> TENANTNAME CONTACTFORPERMIT PHONE(tF�� �`{-/8' 3�}�$�j�CCII� <br /> ��� (1Bt7�)� LiC19r��c� Cr�rl<<G�7ard�? ✓r'���vti. ��r�� <br /> E-MAII. <br /> CONTRACTOR ��w .,���'� ADDRESS CI7y/Z�p PHONE <br /> CONTR.IICENSE# <br /> USE OF BUILDING ' HFAT SOURCE CONTRACT PRICE OF WORK <br /> 1 W$7 r�r1)�fil(� _Electric ✓Gas_Olher -I'��� <br /> WORK DESCRIPTION <br /> K��Ciir�i �f�rredc'l : Re�lale /t�f�heh rrth�nrls, �p�la�C H�Ici�FiiS'���Kj Px�nnd �51n�7c1, a���lSnS <br /> :'ncK�lvp in7o �starr�J, urld ���p sniK i�r/� �slni,d. Reivipc� fi�� st�+�adr��y, nao� /o�+�l i <br /> ��Nn�;v�� wpll. Rerl�x� .2 k� /lh2n w/rc%�vs. <br /> � <br /> PLUMBlNG MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IIEM I <br /> Toilel A/C–air handling units I <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> � Kitchen sink 8 disposal Gas freplace i <br /> Dishwasher __�__ Gas renge <br /> Clothes washer Clothes dryer <br /> Waler heater _� Range hood <br /> 1_ Sink(service/bar/mopletc.) Exhausl fan <br /> _ BockOow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Retrigeration <br /> � _ Grease trap _ Woodslove <br /> '�i I = Roof drains = Olher — <br /> Other I <br /> I — -- i <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i II hereby ceritlty that I have read and examined this application and know the same to be trua and correcL All provisions of laws and I <br /> ordinaces governiny lhis type of work will be complied with wheth�r specified herein or not.The granting of a permit does nol presume I <br /> to give auchonty to violale or cancel the provision of any olher state or local law regulating construclion or Uie performance of <br /> ronstruction. Th�t I am authorized by the owner�f this property lo pedorm the work for which aoplication is made and I comply aith the <br /> �lale Contractors Law 16.27 RCW and 296.200 WAC. <br /> 1'�.C�i"YI,C;�— ��4�1�-�woL- /,>'i � !�•G 7 <br /> Signamre of Ow edContraclodAuthorized Agent Date 1 <br /> I �^l/ <br /> I ----- -�- - -- - ---- ------ ------- � <br />