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( � <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 �—���/ <br /> SITE ADDRESS PARCEL TAX I.D.• PERM�T N <br /> qbl�• P� �� 0�I0I - 01`� <br /> LEGA LOTNO. BLOCK TflACTOR3UBbIV1910NA <br /> DESC. <br /> OWNER ADDRESS IP PHONE <br /> El�Orla�on�P=�n/ '{Ob -f�2Kc l)!L �:+'e-l�' 9�Zo3 QzS-788• /D�JS <br /> TENANT NAME CONTACT FOH PERMIT �PFIIO�N,�`��� <br /> I �i'� f1�-� "r E.���E,��xea�,.�a.��, <br /> ���i�^i4 /25ro5•NE/2lo�-i°` Krx�wrl q�¢ gz�s=�r���� <br /> CONTR.LICENSE If <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /2C-sr a�i n� Elecidc ,�.Gas_Other 3 500 �� <br /> WORK DESCRIPTION <br /> j('�°c.7�c� 6�s �smar�. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C—airhendlinpunits <br /> Balhlub � Forced air systems <br /> ^ Lovatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchon sink 8 disposal Gas lireplace <br /> Dishwasher Gas ranga <br /> Clothos washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(servico/badmoplelc.) Exhaust fen <br /> I _ Backflow preventer _ Heal pump <br /> Urinel Unit healer <br /> Drinking Founlain Boiler <br /> ` Floordrain Refrigaratlon <br /> Groasc trap Woodstove <br /> Rool drains Other <br /> Othor <br /> CITV OF EVEREtt LOCAL SALES TA%COUE IS 3105 <br /> I hareby coritily that I have raad and ezaminod this application and know the same to be true and wrrecL All provisions of laws and <br /> ordinaces goveming Ihis typo ot work will be complied with who�har specified herefn or not.The grantlng of a permit does not presuma <br /> to give aulhority�o violate or cancel the provision of any other state or local Inw regulatinA construclion or the perlormance ol <br /> construction.Thal I am orized by tlia ownor of this property to perlorm the work for which application is made and I comply with�he <br /> Slate Contractors Law 8.27 FiCW and 296.200 WAC. <br /> /•/Z�09 <br /> S' nature ot vmor/ConlractouAuthodzed ent e <br />