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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.evereth,va.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM � `� "—�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERA6�i l� <br /> (�(�2q O�Yr��'�c Dn. u A � `�- OI 1 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��A�J 4 WC�v?r LENSOn1 b625 OlYmnc Ua. VA. (2vtR/o'f �ZS' 3B3 IIOL. <br /> TENANT NAME CONTACT FOR PERMIT PHONE y2j S db•uTb I <br /> I ���� MY.4.�,�NN E-MAIL �tt�r�lw.ttO�tomw�•n1- <br /> '�6FTI�A�TB�— �E�S YI <br /> C.f, . 0 ��,1oK'M�•�(45i IN�. 2$bl T31c{f,�'yd A�<. SnoM�mu�1 ��'=3S-9fJ�- <br /> CONTR.LICENSEN Su�lt (O'j �"'�� �*`� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �S �� _Electric ✓Gas_Other �'-1� W�"�— <br /> WORK{)DESCRIPTION <br /> FC,G[J�I�- �.+n��(�'� In •N/�ykC �jcll- LIL'�C� <br /> Jn iyL��L wnik•.�.- :t-.ic_V 7�.! n.J.( l..�s �.<t"1.« <br /> 'f �.�P6.Z+� � Jf,... (.., t.,v.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub _L Forced air systems <br /> � Lavatory(wash basin) _L Gas piping <br /> Shower Water heater <br /> iCitchen sink &disposal ,�_ Gas fireplace <br /> Dishwasher �_ Gas range <br /> � Clolhes washer _ Ctothes dryer <br /> Waler heater Range hood <br /> Sink (service/barhnop/etc.) _L Exhaust fan <br /> Backtlow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease frap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF NERETT LOCAL SALES TI`X CODE IS J105 <br /> I hereby certify Ihal I have read and examined ihis application and know the same lo be irue and corred. All provisions of laws and <br /> ordinances governing this lype of work will be complied with whether specified herein or not The granling of a permil dces not presume <br /> to give authoriry lo violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.That I am aulhorized by the owner oithis property to perform iho woik for which application is made end I wmply with the <br /> Stale Conlractors Law 1827 RCW and 296.200 WAC. <br /> ���({„(�- 7-3o-/u _ <br /> Signature of OwneNContractor/Authorized Agent Date I <br /> I� <br />