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PtRMIT APPLICATIUN <br /> CITY OF EVERETT �'ERMIT 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.A PERM�7 N <br /> 352.� �a:;.� �v� vo���cxaoe0000� Do��a -c;oy <br /> LEG� LOTNO. BLOCK TRACT <br /> DES�. <br /> OWNER ADDRESS CITY2�P PHONE`_�27�,744 <br /> Si� Rabh\�s �L_1 �e�oT��K":;1�:,. ��'1 t�1v�l Se�\e 1 -425-Z52 <br /> iENANT NAME I CONTACT FOR PERMIT PMONE <br /> �1�.���.-� �T�� �A.,,s �zs-zsz- �� <br /> CONTRACTOR (� ��p\Q fj,� �,q��+4DDRE56 CITY(LIP PHONE4)$-30j$O�IL <br /> CONTR.LICENSEMAF�vRAi10 bC� 373Z Sr��" b`"e u"'�� � E�`�'� `��°� <br /> USE OF BUILDING — HEAT SOURCE � CON7RACT PRICE OF WORK <br /> Electric _Gas Other Q�3SQ � ¢td..�S�on.`a <br /> WORK DESCRIP110N <br /> R2rv��.ri� c�� 13:,��a��r•�, -Y4nt�:��� SI�c-tib5 ��" S`�-' pCe�iS�a'�+c�\ <br /> �� �� S-�-o:-ct e uSQ , <br /> ^ I�Q�J �hG.r� � <br /> PLU ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toil�l _ A/C-air handling units <br /> 6alhlub Forced air��ys!�ms <br /> _ Lavalory(wash bas�^.) _ Gas piping I <br /> Shower Water heater <br /> Kilchen sink 8 disp..sal Gas fire,lace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (service/badmop/etc.) _ Exhaust fan <br /> 3acY.flow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain 4ioiler <br /> F�oor drain Refrigeretion <br /> Grease Irap Woodslove <br /> _ Roof dr,�ins _ Other I <br /> I = Olher— -- — — --- � <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritity that I have read and examined this application and know the sama to be true and correct. All Nrovisions of laws and <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not. The granting of a permit ooes nol presume <br /> to give aulhority to violate or cancel Ihe provision of any other slate or local law reguiating cor.struction or ihe por{ormance of , <br /> cons7uclion. Thal I am authorized by ihe owner ot fhis prope�ty to peAorm the work lor which application is mads and I co�np;y with the <br /> _StateICont!actors Law 18.27 RCW and 296.200 WAC. <br /> `l Y-�� N� � .�.'`.r� ��'rJ—O�o <br /> Signature of OwnedConlrectodAuthorized Agen Date <br /> � -- ----� <br />