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I <br /> P��RMIT APPLICATI�N I <br /> . CITY OF EVERETT PERMIT SERVICES i <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED i <br /> c � <br /> r SITE ADDRESS PARCEL TAX I.D.# PERMIT# I <br /> = oyra-o � <br /> LcGA LOT NO. BLOCK TRACT — <br /> DESC, <br /> ADORESS CITKZIP PHONE � <br /> OWNER (yLSJ33Y'$l+(.�j I <br /> ��� PEWITi 151�{ Rac►'�fEtt.C([. Av� . fvC2£cT 4��{ <br /> TENANTNAME Sqy� ��jfiNCr CONTACTFORPERMIT Nt yL5 - 7y5OLS93 <br /> ANDR�C7 LAPIrJSKI �ND�ZE,r �aPiasKl ,�«,,,_ 2o�- 2Z7- g242 <br /> �7RACTUR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE# SpVE/(+ + U7ODD � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S,/i� _Electric �Gas_Qther � 12��DO. Uc� � <br /> t� <br /> �NORK DESCRIPTION ,r <br /> ��� �� ��� J � I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. IYPE OF F�%TURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Bathtub _ Furced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> _ Ciothes washEr,\ I Ranhe hood <br /> Laundry tray '- — 9 <br /> Sink(service/badmop/etc.) _ Eehaust fan � <br /> Backflow preventer _ Heat pump <br /> Unnal __ Und healer <br /> _ Dnnking Fountain _i t3oiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ bvoodsrove <br /> Roof drains _ Otiier_ <br /> Other — -- <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> �, I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> j ordinaces governing this type of work�.vill be complied with whether specified herein or not.The granting of a permit does not p�esume <br /> Ito give authonty to violate or cancel the provision of any other state or local law rec�ulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> � State Contractors La�v 18 7 RCW and 296.200 WAC. <br /> , <br /> ,Llc � <br /> Signawr of Ow ri o ractouAuihonzed Agent Date <br /> � � <br />