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P RMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� _6._() 6 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT 1f <br /> 24i I ��u��Tr a�� ����o i o0 - <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIiY21P n �PHf�1NE <br /> v � <br /> r� vF�( �IP..E �l(o�i�CS 1�=f�G PO � 2203 ��F2KETT" � �425� Z5� �964 <br /> 7ENANTNAME � CONTACTFORPEHMIT PHONE <br /> EV�e�r� ���� ��u-'+t�e,s �srx, I I�.�'l4rcL O�fb�. �Q2s) �25�- 061�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# / 1/� MG�v <br /> �1U�1��7 ����tii/ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> D��IG� �� /�-(IEETin�CrS �Electric _Gas_Other I '���J�000•p0 <br /> WORK DESCRIPTION , <br /> T�.�I�r �M�ouE�y�� �o� � �Xt��rr� �(LDi�IL� <br /> PLUME!NG MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> � Toitet ✓ Fo ced aihsystems nils <br /> � Bathtub Gas piping <br /> � Lavalory(wash basin) — yyater healer <br /> �$hower <br /> �L i<itchen sink 8 disposal _ Gas fireplace <br /> Diahwasher � Gas range <br /> Clothes washer Clothes dryer <br /> _ Water h�ter _ ange hood <br /> Sink(service/bar/mop/etc.) _ E aust fan <br /> Backflow preventer _ Hea ump <br /> � Urinal �'� _ Unit h ter <br /> Drinking Fountain\ _ Boiler <br /> = Floor drain �'\ _ Refrigeralio <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces governing this lype o(work will be complied wilh whelher specified herein or not.The granling of a pertnil does nol presume <br /> lo give aulhority to violale or cancel lhe provision of any olher slate or loral law regulaling construction or the perfortnance o� <br /> construction.Thal I am auth9�ized by the owner ot tliis property to pertorm the work for which application is made and I comply with the <br /> Stalc Contraclors Law . 7 RCW and 296.200 WAC. <br /> ;G � a-o� <br /> Signature o(Owner ntraclodAuthorized Agent ' Dale <br /> ��2 <br />