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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 ACCBpTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS F'ARCEL TAX I.D.M PERMIT A <br /> `Ic2 n�e�a,,, v� � � Uo5 �ly olyo ao2 �' S/d - v�� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. ��� 1 I y I�J- 02 p�nr C � I�;�e l,�rs t <br /> OWNER ADDRE55 CITY2IP PMONE <br /> Sw�.d v�c�., Cpn+a c+�+-s Lcc �c, (3ax aoy3 ���*+ S81i'S yzs•8�u- 7.zy� <br /> TENANTNAME CONTACTFORPERMIT PMONE <br /> /�A� Qeck <br /> CONTRACTOR SOf1ncIU• Li.,l Co�t�l-IY c1c�'S ADDRESS CITY2IP PHONE <br /> (�o� 3c.F �0��3 �ve.�cff- yzs • J�a - 71v7 <br /> CONTR.LICENSE N g�11 3 <br /> .Sov��IOC,L 95� IC Q <br /> USE OF BUILDING HEAT SOURCE � ¢,ONTRACT PRICE OF WORK <br /> I f� <br /> j (— � _Eleclric �Gas _Othei I �� r 3 G, ��G <br /> WORK DESCRIPTION <br /> /�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel NC—airhandlingunils <br /> �- Bathtub = Forced air syslems <br /> � Lavalory(wash basin) � Gas piping <br /> Shower � Waterhealer <br /> �_ Kitchen sink 8 disposal Gas fireplace <br /> �_ Dishwasher Gas range <br /> _� Clothes washer Clothos dryer <br /> I Water heater 1 Range hood <br /> Sink(service/bar/mop/etc.) _y__. Exhaust fan <br /> Backflow prevenlcr Heat pump <br /> Urina� Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refriyeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat i have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or aoL The granting of a pertnit does not presume <br /> to give authoriry to violale or cancel the provision of any other slate or local law regulating construction or lhe peAormance of <br /> construclion.That am authorized by the owner of this property to perlorm the work tor which application is made and I comply with the <br /> Stale Contra� 27 RCW and 296.200 WAC. <br /> �% z� �1� 1i-vS <br /> Signature o OwnedConlractodAuthorized Agenl Date I <br /> � <br />