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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM g , a �(J� <br /> SITE AD�RESS PARCEL TAX I.D.# PERMIT� <br /> �,30 . w�rJ9 �o�oz s�p �2�, oc� O -,5 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 2 <br /> OWNER pDDRESS CITYfZIP PHONE <br /> t�E�} k�OMEsIt�IC,• 'l�i1b 1438�5`.5.�, �.lot�,,,.���1a �,�2"-�� y�'33p-�i�l�c <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> k'cu..�l-4 �►--�N �k- 33�� 11�i _ <br /> CONTRACTOR I�n�1 �OMr` I��. ADDRESS CITY2IP PHONE <br /> TL��(TI K G✓ -y� !��-y�•-��+�. <br /> CONTR.LICENSEp 1-1�� \"_ ,ts �� �NIO��O�v11`SN I.t_330'G'It �L( <br /> {"�F 4-Tl-FI'Ctd�✓2Gr �IS2`l S' <br /> USE OF BUILDING ��� HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� _Eleclric �C Gas_Olhcr <br /> WORK DESCRIPTION <br /> �I����s� - '��a��244 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> Toilet A/C-air handlinc�unils <br /> L Balhtub l Forcedairsystems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> 1 Kitchen sink&disposal = Gas fireplace <br /> � Dishwasher Gas range <br /> Clolhes washer � Clolhes dryer <br /> � Water heater 1 Rango hood <br /> �_ Sink(servlce/badmop/alc.) 3� Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit hoaler <br /> _ Drinking Fountain Boiler <br /> Floordrafn = Rofrigeralion <br /> Greaso lrap Woodslovo <br /> Roof dratns Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby cerilify thal I have read and examined ihis applicalion and know the samo l0 6o true and corroct. All provisions of laws and <br /> ordinaces governing lhis lypo of work will be complied with whother specified herein or no�.Tho c�ranling of a permil doos not presumo <br /> to givo authoriry to violale or cancel the provision of any other state or Iocal law regulating construction or tho performanco of <br /> conslruction.Thal I am a lhorized by Ihe ownor o(lhis property lo perform lho work for which applicalion is made and I comply wilh lhe <br /> St�e Conl ctors La�1 27 RCW and 296.200 WAC. <br /> (�_ 'rJ ' c7� <br /> 3ig�aturo o(Owne�n�i,onlracta/Autl onzed Agent Date <br /> ��] <br />