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l _� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everellwa.org <br /> APPLICATIONS ARE ACCEPT'cD FROM t AM T04 PM 6 `�� '�D <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT R <br /> !41(� New'�tt Ave. 0o439�esio3soo ClooG -oi� <br /> LEGA LOT N0. BLOCK 7RACT OR SUBdN&ON• <br /> �S� 35 (og� E�ete++ Pla+ <br /> OWNER ADDRESB CITY/LP PXOME <br /> R�c,k �...ap�nsk� P.o. Qox �9� g five�ett 98�01, Wzs) �oq-Y35� <br /> TENANT NAME CONTACT FOR PERMR PHONE �I.ZS• 33O•'7 77 3 <br /> SC�.U6S SQoc�s Carille�LLG R�c.�C Lap'�ng�c�t �„N� rlPcopseYahoo•ca� <br /> � <br /> �wner <br /> �o�.��»�. So.ma�a�e�'�eri�ny �-lo?S-3$1 -qlo�4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Res�l'a�co.�� JBa� _e� �ceg_a�� I a�,�(�0� <br /> WORK DESCRtPTION <br /> Tena�� 'In,p�ovem��� fo� �RCg'�qufan� �a�f <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. M8 OF FIXTUIIE OR ITEM <br /> Toilet A/C-air handlinp unita <br /> BaMtub Foroed air systems <br /> Levatory(wash basin) Gas piping <br /> Shower Waper heaMr <br /> � Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher � Gas range <br /> _ Clothes washer Clothes dryer /� <br /> Waterkeate.r .!-� Rengehoad�nLu�.l� SG��+^�� <br /> � Sink(servicelbar/mop/etc.) � Exhaust tan � <br /> � Bedcflow preventer Heat pump <br /> Unnel Unit heakr <br /> Drinking Fountain Boiler <br /> � Floordrain � Refrigeration <br /> 1 G2ase t2p Woodsrove <br /> Roof drains Omer <br /> Other <br /> CITY OF EVERETT LOCK SALES TAII CODE IS 7106 <br /> I hereby certify 4iat I have read and examined Mis application and kraw the same to be true ard cortect. Ail provieio�n of lawa and <br /> ortfinenoes goveming lhia type ot work will be complied with whether apecified herein or not.The grenting ot a pe�mR does not p�eaume <br /> to give authoriry to violate or cancel the provisian of any other state or local law regulating canaWclion or the per/ortnance of <br /> construction.Thal I am authorized by the owner ol this property ro perfortn the woAc for which application is made and I comply with the <br /> State ntractors Law 1 .27 RCW and 296.200 WAC. <br /> e- �v- O - �.� <br /> SignaNre of OwnedContre odAu � ed Agent Date <br /> t lZ <br />