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c <br /> 1 JPELMIT APPLICATLO.14 <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 ACCEPTED FROM 8 AM TO 4 PM — DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> ils <br /> SITE ADDRESS -1S d � i PARCEL TAX I.D.# PERMIT# <br /> Ven VicL GI 006055-0 2 -010Z-60 8yr2--cry F <br /> LEGA. LOT NO. ✓ BLOCK `� TRACT <br /> DESC. '.2- 7 <br /> OWNERr�f ADDRESS CITY/ZIP PHONE 64-65-) <br />- i-)I..:(1:;: <br /> .i! 7 (1C06(:)00 I ✓ 0 g EvW,KECo&AY EV f r FPOS 257- 006 <br /> TENANT NAME CONTACT FOR PERMIT PHONE a <br /> >rrnkr_ ,.- i_ r i Bre::C-K.LA, A 1.1 l`i <br /> CO TRACTOR ADDRESS CITY/ZIP PHONE <br /> PP'ox Coy i/r ciw,2 6-TO y glen ilwx ( c 5 -0 /a LIPP <br /> , + l <br /> CONTR.LICENSE#p� �� 0� P / 9 - -7- °Li ar" y <br /> gL9 c_ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK y4 <br /> 0412 `' viv d, (:,--.0.a, 6(e _Electric _Gas_Other • <br /> • WORK DESCRIPTION <br /> ps- 39 <br /> U) .' ' <br /> por,arop l or (.,,,,v/46 <br /> IF PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> — <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> TAXD <br /> CITY OF EVERETT LOCAL SALESCODE EIS 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 /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating 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 Law 18.27 RCW and 296.200 WAC. <br /> i • r <br /> ,x1 41,,4"-.,- /A:3 1,e1-- —(.'o,uTM(lot? <br /> 01/-O`( <br /> Signature of Owner/Contractor/Authorized Agent Date ik- <br /> i <br />