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( <br /> PERMtT 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 � �a7�Qg <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> � � r 20 3 C7 ' (��J� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. i � E , <br /> OWNER ADDRESS CITY2IP PHONE <br /> I��,� I Ql�o� ItiIR C�.a� l A�e�e Eve�+F98zoi 4L5-311-OISS <br /> TENANTNAME I CONTACTFORPERMIT PHONE i1.h.�42S-3�7-O� SB <br /> Ce�l -�425-8TU 'SS64 <br /> �( ri a��l M�c4e11c Olso�-, Kca�� OIScv� E•MAILkar�i-ol5on@ M�ri.com <br /> NTRACT R � ��e y p�e�-/ TMe Re-�u(1 ADDRE § � � H <br /> I'73o4 57"'9L w«F Ly-+��ooa "'��Zo6-9i s-5816 <br /> CONTR.LICENSE fl PE�'QG*�O 53Q2 98037 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I\eSiG��.-��'n,�� F-c .�+y I�oc��n —Electric �Gas_Olher A��7loX �3���0�• � _ <br /> WORK�?DESCRIPTION <br /> Hc�c�i�iG�t �� �, r'clCn� C'VC-' GuY �a�n�L., /��sC,cU� �,✓; Il L� ��SI.,cJ <br /> „ �clows w,i .��ukk e,c��+� .,� s�d„�q <br /> r"�u�V��✓� i,uin�.�ci�s �7 ����iu-�c�^ L'Ki Sfi �t k/�t ttNCt � � � J • <br /> �7a.� Mi'^��. I1uS a�, �rd� � '✓� ,� � _II,�' „ r- �r-u� <br /> — PLUMBIN MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet P.�C-air handling units <br /> — 82������ _ Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Showcr _ Walerhealer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Waler healer Range hood <br /> Sink (servicelbarlmop/etc.) _ Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinkin9 Fo�ntain Doiler <br /> Floor drain _ Refrigeration <br /> Grease Uap _ Woodslove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application anA know lhe same to be lrue and correct. Ail provisions of laws and <br /> ordinaces governii�g ihis type ot work will be complied wilh whether specified herein or nol.The granling of a permit does nol presume <br /> to give aulhority to violale or cancel the provision ot any olher state or local law regulating consWction or the performance of <br /> construclion.Thal I am aulhorized by the owner of lhis property to per(orm lhe work(or which applicalion is made and I compty with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> -�//� �� 4/1-�/C�j' <br /> Signa�f wner/ContractodAulhorized Anenl �ale � <br /> � L <br />