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. � <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, 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.# PE�^IT# q <br /> i� l `� R�,k�.���l! �� �7 ��'� `/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITI'IZIP PHONE <br /> `'115. Sltpv� CV�oss t `tl `( R�.,K,x��e.l�ev "�,. . z��9- �z :v <br /> TENPNT NAME CONTACT FOR PERMIT PHONE <br /> / i�vi-_ /cinJtk��TY ��11�J�61G1�- 2S 1-72J'b <br /> CONTRACTOR L�ftLl`(—�� �jfll��'tEj.(1 ADDRESS � CITY2IP PNONE <br /> t3OX [2�'l CzU %�zc�, Z l'�-7ZCti� <br /> CONTR.LICENSE k ��V n LT��Y�L.7 <br /> USE OF BUILDING '�� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �?{/�l�-��C"�c ic _�her l ��� � ��ZI <br /> ,1 <br /> WORK DkSCRIPTION <br /> Cc7NsTG�U�-j�U� C�i— ZU� �Cz�F` �a--���(J rR-4t61.�� C'�1'kuz�y�-T�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC—air handling units <br /> BaUiWb Forced air syslems <br /> Lavatory(wash basin) Gas pi ' g <br /> Shower Waterhe r <br /> Kitchen sink 8 disposal Gas fireplac <br /> shwasher Gasrange <br /> Clo s washer Clolhes dryer <br /> Water h er Range hood <br /> Sink (service /m etc.) Exhausl fan <br /> Backflow preven Heal pump <br /> Urinal Unit hca r <br /> Drinking Fo lain Boiler <br /> Floor dr ' Refr' eration <br /> � Grea irap W dslove <br /> Roo drains � O er <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhat I have read and examined Ihis application and know the same to be true and correcL Ail provisions of laws and <br /> ordinaces goveming this lype o(work will be complied with whether speci(ied herein or not.The g�anling ot a permit does not presume <br /> to give authority lo violate or cancel the provision of:iny other state or local law regulaling consWU�on or lhe performance of <br /> construction.Thal I am authorized by the owner of this property to perform the work(or vehich application is made and I comply with the <br /> Stale��ntract w 1�7 RCW and 296.200 WNC. <br /> i��-Z!' r�� ���.-< � ��V- � <br /> Signature of Owner ContractorlAulhonzed Agent Dale I/L <br />