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P�r2MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES I <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810— FAX 425-257-8857—www.everethva.org i <br /> i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBiT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE MIT# I <br /> 1527 UC/lE� R!/�, vv5 '3632 ° �Ea �? -1 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ,('-OTS � io 3z 3 ,�-av - REmi��ro.�s /57 Ra,o, <br /> OWNER � ADDRESS CITY2IP PHONE <br /> �EFJ_'E L, r�Elp'�SE� %S27 RUC�iL EI/2%, '`f�?5 -252 —`�66"L I <br /> TENANTNAME CCNTACTFORPERMIT PHONE <br /> �/�'E MALGrY �� S- �7U - /�'fU <br /> CONTRACTOR �f'�A�Qy' CU/�S/�L�GT�O/ ADORESS CITY2IP PHONE <br /> /`f3,�, �2Nn Auc, �.cJ, M.s��. �f8.2�� 'f_1s,8?�-/f�s'o <br /> CONTR.LICENSE# �A� VC ,C7 7 D� <br /> l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S�^�4LL-' FA/h. �S/QG7JCF_" X Electric hGas_Other �'�-a� �gX� 5 Aavilic•�) <br /> WORK DESCRIPTION <br /> N/�i�iTio:J T Ek.srini�: �F�siar.�cF, <br /> %0 �/J CL!/r_1 t� /�'157n. 8,�-�2oah, B�97�+2aaM, 1 a X �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> � Bathiub Forced air systems <br /> � Lavatory (wash basin) Gas piping <br /> _ SMewe�, SHQ(Jrkoe2�'7�,-p Waterheater <br /> I _ Kitchen sink& disposal Gas fireplace <br /> iDishwasher Gas range <br /> T Clothes washer / Ctothes dryer <br /> I _ Laundry tray Range hooC <br /> i _ Sink(servicelbar/mop/etc.) 2. Exhaust fan I <br /> I = BackOow prevenler = Heat pump <br /> Unnal Uni!heater <br /> Drinking Fountain Boiler <br /> � Floordrain lf �j _ Refngeraticn <br /> � _ Grease trap ^ �,L �� Wood.;tove <br /> ; _ Roof drains ����-uJ� _ Other <br /> ' = Olher � • I = <br /> i <br /> C�TY OF E'/ERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify:hat I ha�-e read and examined this 2paiic�ticn and know the same to be irue and correct. All provisions oF;dws ar.d <br /> ordinaces governing this type of worrc•.vill te complietl�.vdh�,vhether spedfiea herein or not. The granting of a permit does n�t piesume � <br /> to give authonty to •�iolate oi :ancel the provision of any other state cr'ocal �aw reaulaung construction or the performanu:o' � <br /> � wnsvuction.That I am authonaeo hy;he owner of:his prcparty;c ;er`orm the work ier�.vhlcn application is made an'. I ccmply with the <br /> State Contractors Law '�8.2i RCIN anG 295.200 VdAC. <br /> ) � �.� /1 2 -� s - o.S <br /> � Signature of Owner; 'onhacto:;A�' .uizec ncent ��2tc �I� <br />