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PtRMIT ARPLICATIVN <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 /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM �y Iv7 6 ( ' 7 <br /> SITEADDRESS PARCEI TAX1.D.# PERMIT# ��N`��"�� <br /> ��.�C� l�u��� e � D2. _�—_ _—� -�'-rL�STiT�oz�_ <br /> LEGAL LOTNO. BLUCK � TRACT — <br /> DESC. <br /> OWNER AOURF55 � CITYlZIP PHONE <br /> /`1 �c�ac� Allch Gv�ns4r�,,c.�¢�. 1 �33,� d�crr�.� �dv� nl =d-�o� s,�ili sku�c�,�t�vl 7 (3,j <br /> TENANTNAME CONTACTFOI:PERMIT PHONE <br /> � c�-� -J o 1��.�,sv v� ��t�s- ,� �S- �3;:� <br /> CONTRACTOR ADDRESS C1TY21P PHONE � <br /> /�1ic.�nuc1 ,4llc.n GvwSEru�{'�o"� ��.� �i6 /lufa�t Arlt'�i/ SLtGtuc"� t�,tS- 175 .ts�' <br /> CONTR.LICENSEp �J.O � 5��:���- �f��S j , <br /> :�1.1�1� MIU��,4c9�le��rb <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric _Gas_Other �3 �y Q� � <br /> �� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A�C-air handling unils <br /> �alhlub Forced air syslems <br /> Lavalory(wash basinl Gas piping <br /> Shower Waler heater <br /> Kitchen sink& uisposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer 1L Clothes dryer <br /> Water healer �_ Range hood <br /> Sink(service/harlmop�etc.l ,� Exhaust fan <br /> Backflow preveNer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refriger2tion <br /> Greasetrap \Noodslove <br /> Roo(drains Olher <br /> Other _ <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined ihis applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming Ihis type of work will be complied wilh whelher specified herein or nol.The granting of a permit does not presume <br /> to give authority lo violale or cancel lhe provision ol any olher stale o� loca�law regulating construclion or the pedornance of <br /> \ consUur.tion. That I am authorized by the owner of this property to peAorm lhe work(or which application is made and I comply with the <br /> S�ate Cqnt�clors � .w 1fi.27 RCW nd 296.200 WAC. <br /> / / � �-�_Q• <br /> � <br /> �' tur " f npr n reclor/Authonze c�ent Date <br /> � <br />