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PEFtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 4?.5-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEp fROM 8 AM TO 4 PM � --I a�I'3 <br /> PARCEL TAX I.D.# PERMIT 8 <br /> SITE ADDRESS y� _ �J� <br /> (c 0�=-�o `M2v'�CS �c.. Ai7L !X.>"7 O a o[� '� O O <br /> I.EGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> vvs - s�y- �i�s�, <br /> �C.Sic.r �� 4�• U Vhe�r ;���o.n � • �e .-, <br /> TENANTNAME <br /> I CONTACTFORPERMIT PHONE <br /> ADDRESS LITY2IP PHONE <br /> CONTRACTOR �( �L y.� �y �{Q_,��-;n� 1 G ,���� �Z <br /> � 4025 t.� ,...e�.. ,�..) t�-� �c 3c.o• 5 8 <br /> CONTR.LICENSE# Snol.,>��..�,�h � F•L50 <br /> kAl.w, G l'� aKcSG(.�dD <br /> U�E OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I Electric .�Gas_Other � 3y�k, °C <br /> WORK DESCRIPTION <br /> \� Q\5 C��e�J C4 5 ��vrG�t � \��, K_,t� �L�C ���Ci�. <br /> ) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> A/C-air handling units <br /> _ Toilel � �orced air systems <br /> Bathtub Gas piping <br /> Lavatory(Wash basin) — yyater heater <br /> _ Show�r —' Gas fireplace <br /> Kilchen sink 8 disF�sal Gas range <br /> Dishwasher Clothes dryer <br /> C�othes washer Range hood <br /> Water heater Exhaust fan <br /> Sink(service/bar/mop/etc.) Heal pump <br /> BackOow preventer Unit heater <br /> ;� — Urinal _ goiler <br /> Drinking Fountain Retrigeralion <br /> i Floordrain Woodslove <br /> Greasetrap Other <br /> Roof drains -- '— <br /> Other — — <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y ihal I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or nol.The granling of a permit does nol presume <br /> to give authority lo violale or cancel tho provision of any other stale or local law regulating consWclwn or the performance of <br /> conslruction.That I am authorized by the owner of this property to periorm lhe work for which applicalion is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> (1 � �o Q�, ?-- 12 - l 3 <br /> gig�yt�e oT OwnedContraclodA honzed Agent Date <br />