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-1 <br /> PERMIT 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 �p -a'3--D � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> JSOo Hcw=�' A�� O�IL-01� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> I-�QAI'FI�Sb«'fh I Peler L��1\�sve. `l�5-gKl � 01ot� <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> lva�,Fe�.�• Sl�.�es F:�n l�.vlecl:o•. Ti0'� l60"` N�e. NE (Z¢d.++o�d kas- �si- o�oo <br /> CONTR.LICENSEN 5`^`le �-��' 9805� <br /> wESTCsF iibG�= <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> {�eRI�H-.care -��.cil�ly <br /> Eledric Gas Olher � �6a` <br /> WORK DESCRIPTION <br /> Relo�t�a� d" OLt[tl}ibh � ��.,k�c,- c.�l, a,,� +� -�z„a...t �.p.���r.e�-i <br /> Sp�.ct�..9 co�Plies wtth NFPR 13, <br /> PLUMBING MECHANIC!►L <br /> NO. IYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry lray _ Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhausl tan <br /> Backflow preventer _ Heal pump <br /> Urinai Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease rap _ Woodstove <br /> kooi drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritify thal I have read and examined this application and know the same lo be true and corted. All provisions of laws and <br /> ordinaces governing this type of work will be wmplied with whether specified herein or not.The granting of a pertnil does nol presume <br /> to give authorily lo vio�ate or cancel ihe provision of any olher state or local�aw regulating construction or the performance ot <br /> .:onslruction.That I am authorized by the owner of lhis property to peAorm the work for which application is made and I compiy with the <br /> Stale Contractors Law 1�.27 RCW and 296.200 WAC. <br /> �� a/�( IO/13IO�v <br /> Signature of OwneNConiractodAuthorized Agent Date <br />