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F�RMIT APPLICATI�N <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 AFtE ACCEPTED FROM B AM TO 4 PM -DEBIT 8.CREDR CARDS ARE NOT ACCEPTED <br /> SI7E ADDRESS PARCEL TAl(I.D.# P,(�RMIT N <br /> ���(r. (,c:�c��ti-or � .�U <- � �43`7aya�Fo �-;�p I 'J..i S �S' �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER - ADDRESS <br /> C�L. �� `�� CITY2IP PHONE <br /> vctv.c�c'c� L�. �.+-_-�•.� � .. o O �Jl�v� '"^oYF U c re� �SZ-O I �{ ZS"Z52-�ZQ� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I �� G�so.� �/Z � zs9- i3i� <br /> CONTRACTOR /}C�r-i( L�,¢P/��B� I,t�C ADDRESS CITY2IP PHONE <br /> CONTR.LICENSEN 27Z(v �ucrc.-2 ,q„�� �v,ez; yg7�� c�Z� Zsy.�g�i <br /> i�,�l�F�� D88�/`� <br /> USE OF BUILDING I — 1i�pT SOURCE I CONTRACT PRICE OF WORK <br /> l'0.4�-6�E i�1 C7NC•s Z Z 6CX� <br /> Electric Gas Other I , <br /> WORK DESCRIPTION p`O(�YCC /3U Eq4PA-Cr(-r <br /> (� � A�eo Ov� <br /> ����a c� S j'- <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XiL'RE OR ITEM <br /> _ Toilet A/C-airhandlingunit:; <br /> _ Dathtub Forced air systems <br /> _ Lavalory(wasii basin) Gas piping <br /> Shower Water healer <br /> _ Kitchen sink&dispo I Gas fireplace �// � <br /> Dishwasher Gas range ��- <br /> _ Clothes washer � Clothes dryer <br /> Laund tra — g <br /> _ Sink(servicelbadmop/etc.) Exha st fan <br /> _ Backflow prevenler Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains OtherA <br /> _ Other — _ <br /> qN OF EVERETT LOCAL SALES 7A7C CODE IS 71P5 <br /> ' hereby ceritiy that I have road and examined this application and know the same to be lnie and correct. All provisions of laws and <br /> ordinaces governing Ihis type of work will be complied wilh whether speciTied herein or not.The granting of a permit does not presume <br /> to give auihority to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> conslruction.That I am autliorized by the owner of this property to pertorm the work for which application is made and I wmply with the <br /> State Contractors Law,1827 RCW and 296.200 WAC. <br /> c�cL---.S v-c_ C��..�,,.,._�`\ S-3 -c��- <br /> Signature nf Ov.�nedComrector/Authonzed Agent a(e � <br /> � y , <br />