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MRR-14-200r 11:47 FROM: <br />T0:14252578857 P.4 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 .:EDAR STREET, EVERETT, WA 98201 <br />425-257-"s810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - �EBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITEADDRE��O� �� � EL_ .7AXI.D.N PERMIT/ <br />C���{L�r�3 ai.3� il%. �l_ 3 �' <br />IEGA LOTNO. BLOCK T TAACT <br />�JMcv�J �q �dnm- %.'x�2 �ec..� Ji`" � �3 � 3s35�3Z <br />TENANT NAME I CONTACT ON PE�IT !� ' PHONE <br />J�j_��_ ��/t �i 7� %%O>?aQ <br />CONTRACTOR/ _. aPy nv� /�ORE99 CIN�2�1LP � PHONE <br />l.Y/ / /U �yl (�1 ��dr%%��C l�4-77�-C �+ i�/ 2�d��w <br />CONTR.LICENSEII ��� � U��, <br />�.�,a.. r,u i�= ra7 in/Z !4'�L � �t/7¢ 7T/ `f S - <br />USE OF BUILDING <br />f� <br />— HEAT SOURCE � CONTRACT PRICE OF WORK <br />Electric /�Gas_Olher ���� � <br />WORK DESCRIPTION �� �� � <br />�� � q4.� <br />NO. I TYPE OF FIXTl1RE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Snower <br />Kitchen sink 8 dlsposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (sorvicelbar/mop/etc.) <br />Backflow preventer <br />Urinel <br />Dnnking Fountein <br />Floor drain <br />Grease Irap . <br />Roof drains <br />Other <br />NO. I n'PE OF FI%TLRE ON ITEN <br />AIC — air hendling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gaa fireplace <br />Gas range <br />CbNes Cryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />ReMgeration <br />Woodstove <br />Other <br />Citt OF EVERETT LOCAL SALES TAX CODE IS NOS <br />I hereby ceriHfy that I have read and examined this application and know the same ro be true and correct. All provisionn of laws and <br />ordinaces governing lhis type of work wlll be complied with whether specified harein or nol. The granUng of a permlt does nol presume <br />to give authoriry to vio�ate or cancel the provision of any other state or local laiv regulaling consWctlon or lhe per}ormance of <br />construction. That I am authortzed by the owrcer of this property to perlorm the work for which applkation is made and i comply with the <br />Slate Cpntraclors l.a 1 27 RCW and 296.200 WAC. ?� `� <br />%T� L ,.,0 rA..� J�A' � `1/6 <br />