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� . <br /> PtRMIT APPLICATI�N <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 /> �-t /U /j-'� APPLICATIONS ARE ACCEPTED FROM 8 AM TC� 4 PM <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT ft <br /> iit26 Pk�N � r�k �u w�Y ?vs3� ODoIJ/� � ��1oC� -c�� <br /> LEGA LOT N0. BLOCK TR T OR SUBDIV N#� —L ^ <br /> DESC. l �Y.{ ,LQ Y�/ ._1"� o�� <br /> OWNER ADDRESS CITY2IP PHONE <br /> � I<bTb/�G' `TSoic ISio ► � 2�� av� W �{� o��ou� W�- Rg�37 <br /> TENANTNAME CONTACTFORf'�RMIT PHONE <br /> w 'T L c E-MAIL <br /> T A R AD R / U <br /> (�bblesTo�E coT,�Gr rhrni�y..S l(� �,�wr � ,�s ,�pa�,� 2o6�22G-���� <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> SC� _[leclric _Gas�Other <br /> I <br /> WORK DESCRIPTION <br /> � �ro�y P�H� ic �y� <br /> s_r- P/�- o �" -�, �-G 4t� X L� zo f�-6 <br /> PL.JMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ItEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilct NC—air handling units <br /> 6alhtub _ Forced air syslems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sinY,&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BacY,��w prevenler _ Heat pump <br /> Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep _ Woodstove <br /> Roof drains Other <br /> Olher _ — — <br /> CITY OF EVERE7T LOCAL SAIES TAX CODE IS J105 <br /> I hei:by ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming Ihis lype ol work will be complied with whether specified herein or nol The granling of a permit does nol presume <br /> to give aulhorily to violale or cancel the provision of any olher state or local law regulating construclion or the periormanc�of <br /> construclion.Thal I am aulhorized by Ihe owner of this property to perform lhe H�ork fer which application is made and I comply with lhe <br /> State ConUactors Law 18.27 FCW and 296.200 WAC. <br /> i��'� ��-_ - 61�10� <br /> Signa�urc of OwnedCo tra lodAulhorized Agenl Date I <br /> 1 Z <br />