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P RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 (�_D -� ,�Z <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org 7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C/DO 6 —'� 3� <br /> SITE ADDRFSS PARCEL TAIC I.D.N PERMIT It <br /> � c�� �s - Pa�+cst w I�n - �os3�19�000 �500 _ <br /> LEGAL LOT NO.� BLOCK TRACT OR SUB,D�'MSION M <br /> DESC. r',�p(-� SUbo�JSlbv� #' �l' �� <br /> OYJNER ' ADDRESS CITY2IP PHONE <br /> 17CydJ� FN� LL-� �`10;2 3S�''W✓< Sk � 1 q�[vt2 4zS•�43•►��y <br /> TENANT NAME CONTACT FOR PERM�T PHONE 1.�2S- �7 3' � � <br /> I LNh �-I�I-L� E�AAIL <br /> �R�L $ <br /> ��la�r F.vr�. LI.C., <br /> CONTR.LICENSE M <br /> ►9DpIREL03ZL1 1�03Z �� �v� 5� hvMcl� q�Ul2 NZS- 14 ' I�IY <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SFR _ei,a� X caa_ana� � 14U , �W <br /> WORK DESCRIPTION ' <br /> S� � ��`'=��� G�j�t,���inoP ���C� 3�/ <br /> — PLUMBING MECHANICAL <br /> Np, TYPE OF FI%TURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> Toilet Q NC-air hendling units <br /> Bethtub � Forced air systems <br /> Lavetory(wash basin) ,� Ges piping <br /> Shower � Weter heater <br /> Kitchen sink&disposal �, Gas fireplace <br /> 1 Dishwaeher � Gas range <br /> T Clothes washer � Clothea dryer <br /> � Water heater Ranpe hood <br /> 6 Sink(service/badmopletc.) i�� Exhaust fan <br /> � Beckflow preventer O Hert pump <br /> � Urinel � Unit heater <br /> O Drinkina Fountain Boiler <br /> � Floor drain � Refrigeretion <br /> �, Grease trap � Woodatove <br /> U Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAI(CO[c IS 1106 <br /> I hereby ceAify that I heve read and examined thfs application end know the seme to be true end corred. All proviaioru of laws a�d <br /> ordinances goveming thia type of work will be complied with whether spacified herein or not.The granting of a permR doet not presume <br /> to give authority to vidate or cancel the provision of eny other state or locel law regulatinp construction or the perfortnance of <br /> construction.Thet I em authorized by the owner of this property to perform the work for whlch appliceNan Is mede and I comply with the <br /> State Contradora Law 18.27 RCW and 298200 WAC. <br /> � �- - \ 1 k�J�V lN � `�'QI I �l �/> <br /> Signature af OwnedContredod thonzed Agent Dats � !/ <br />