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i <br /> PtRMIT APPLICATIC�nI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4 � 6 "�a <br /> SITE ADDRESS PARCE:.TAX I.D.iF PERMIT i� <br /> ��o� 23� a� w, EvE�etT1 2�c�o2oozoo7oo � �o? � r�o/ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> NED �Gn✓S �J9d2 NF_ q7l� Sf �ea�l'�< WA 981�5 2od�515-G2Z <br /> TENANT NAME CONiACT FOR PER!NIT PHONE <br /> /�URAG fjMB//GiIn��L- /�l�ke C'a/l,�s 415� 794-8735 <br /> e-ena� <br /> i <br /> /aQlva�ceJ Fre O�o-leca�on /.'a �3v�c /593 Wond�n��ilc y15)9rs3-s6s� <br /> CONTR.LICENSE# yV✓ANFn/q��6 W'� ��0�� J r,,��;anpAdyFK-•/1 r <br /> USE OF BUILD�NG HEAT SOURCE CONTRACT PRICE OF WORK <br /> Of�C�' _Eleclric _Gas_Other �J .���BnU <br /> WORK DESCRIPTION /��� � � <br /> � <br /> ,jn�S�G//u �un oLca qew NFPA /3 l��hf u7G�d 5(�i�nKlPi �yS-}cr� ,s���pl��n5 f�v,� <br /> un ex�s-1,•�� 6�� st��e� <br /> � PLUMBING MECfIANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boi�er <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAJC CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined lhis appiication and know lhe samA lo be lrue and correcL All provisions of laws and <br /> ordin2ces goveming lhis lype of work will be cornplied with whether specified herein or not.The granling of a permit does nol presume <br /> to give authority to violale or cancel the provisiun of any other state or local law regulaling construction or the peformanc=of <br /> construclion.Thal I am aulhorized by lhe owner of this property lo per(orm lhe work for which application is made and I comply wilh the <br /> Slate Contrac ors Law 1827 RCW and 296.200 WAC. <br /> ! C�9a�h�n /�'l;lion Q�- t9y-lO <br /> SignaWro of OwnedContraclodAuthorized Agenl Date '/ <br /> Z <br />