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(� 2 ���� <br /> F <br /> RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES n/ <br /> 3200 CEDAR STRFET, EVERETf, WA 98201 � � .� "v y0 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS PARCEL TAX I.D.# �P�ERMIT� _ � <br /> o��I 1�ih�, rv��ve �c �.� - �;���: �a �n.n_o �3 5 <br /> LLGAL . LOT NO. BLOCK TRACT <br /> L ESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> n J I�d}O <br /> �P ✓`�e ilc��+i IL��hi 1�: ��%tj4�1� rnA+�sv��l•, I'1��1 3bo 153-.::;h'z <br /> TFNANT AME � CONTACT FOR PERMIT PHONE <br /> /v� U6cr�- <br /> CONTRACTOR _. � f AODRESS �l� f PHON�/� <br /> J�.��,.ie ��L:w� �� � cc <br /> / � C'' !�✓ !L'b iirJ ✓/Ctr <br /> f,ONTR.LICENSE# 4�s ,r���' f'l,3/�' <br /> USE OF BUILDING HEAT SOUFCE CONTRACT PRICE OF WORK <br /> �3_ J <br /> f� ��-��cE,4 n:�- _Electric J�Gas_Olher — - - <br /> WORKDESCRIPTION r�ISL C�.X�S��'�?!. �lo„yQ � �lo�.,� �{vv.�dl+}i� Lvy�o�� y.z;-��lu»�, � New�v�f <br /> V <br /> 'Tc{�cl _1l�--- J.. '�� iA /'tar' J� Cl�. �u,•'G l��c,.�.,..1 �a ✓�c <,./ C�� ��cr�� f.i�� «/� 4«cr� <br /> � . , � <br /> /�-. .�>:. � : . , • .' <br /> �. PLUMBI�'G MECHANICAL <br /> NO. NPE Of FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel 1 < 'u �^} � n�✓ d A�'C-airhandlinpunits <br /> .I �athlub o Forced air systert s <br /> ? Lavalory(wash basin) 1 �+�s I, I no.,� _ Gas piping '' <br /> �_ Shower � ����+� � '"^' _ Walerheater� <br /> 1 Kilchen sink 8 dispos�l Gas(ireplace � <br /> � Dishwasher i Gasrange <br /> I Clolhes washer ' �_ Clothes dryer <br /> 1. I W;3tcr healer n�,�y+,� h'r..." - n, d�.�a�; Range hood <br /> C� Sink(servicelbarlmopletc.) 1_ Ezhaust f2n <br /> Back(low prevenler ' _ Heat pump <br /> �'� Urinal Unil heater <br /> ,� c� Drinking Founlain 1 Boiler � G�oo.- Iv.�" <br /> I _ Floordrain _ Refrigeralion <br /> �^ Grcase lrap Woodslove <br /> I i _ Roo(drains _— = Other ---__ <br /> Oiher <br /> I I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined Ihis applicalion and know the sam�lo be true and carrect. All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied wilh whether speci(ied herein or not.The granling of a permit does nol presume <br /> to give authority lo violale or cancel Ihe provision ot any other state or local law regulatinc�construction or ihe peAormance ol <br /> construction.Thal I am authorized by lhe owner o(ihis property to periorm the work(or which application is made and I comply with tha <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �,;,i i --1'. .�p (�. c�-t. <br /> SignstuPe ol�wnen oNractol Aulhonz d Agert Date <br /> \/ <br />