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PE.lMIT APPLICATIOti <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPI ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I,D./ PERMIT A� <br /> ��i7 �i� �� Sc��r� -r��� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE33 CIiY21P PMONE j�y}19�� <br /> ivi� f��'� <br /> /b/�u/ L/a.i�t� !/atU o,� f-IuK:./�i u-w�.}'�- Lao��� <br /> TENANT NAME �C�O TACT FOR PERMIT / PHONE <br /> f=1�Li,C`y �f.11T/��l,CL� S I /fQ/�E/7 /�/�[� L`/r�S) o?S�S-�IOIO <br /> CON7RACTOR ��yKs�.}/�CG �/IrtiJ iti�• ADDRESS �.11� EbEFh? CITY2IP PHONE <br /> p�� EvEReTr 4�T'd. T�j -�rFc- 1 <br /> CONTR.UCENSEN /'n�St{S�G ���I�� 9v(Ju� <br /> v� � (\ <br /> USE OF BUILOING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �$�� - '�����K� ��� <br /> i��V �i Electric _Gas_Olher <br /> WORK DESCRIPTION — n �� L ' �J^ , <br /> S�/��C��, fx;�fr7tQ��t� �-i9�t�� �v a�i�.s�G cq�� �tl �( �6ru� �, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> Toilet _ NC—air handling units <br /> Bathtuu _ Forcedairsystems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Cbthes washer _ Cbthes dryer <br /> Laundry tray _ Range twod <br /> Sink(servir.e/bar/mopletc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Bo(ler <br /> Floor drain _ Refrigeration <br /> Grease trap _ W�dslove <br /> Roof drains _ Other _ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS�105 <br /> I hereby ceritity that 1 have read and examined thi.:application and know lhe same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grenting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stato or local law regulating constructlon or the portortnance of <br /> construclion.That I am authorized by the i�wner of lhis property to perform the worlc for which application is made and I comply with lhe <br /> State Co raclors Law 18.27 RCW and 296.200 WAC. <br /> `' ,�au�c�.���=Cj ic � o.� <br /> ,- � <br /> SignaG re of OwnedContrac6 r Aulhonzed Agent Date �l2 <br />