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/ " 4S/,S/?cSL �– <br /> P RMIT APPLICATIO <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 982G1 <br /> 425-257-8810— FAX 425-257-8857—www.everettv�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TNC i.D.# PERMIT# <br /> 19 ! � y,pi; s,G. �? �;i �vc3c� ����� I �_ -�7'/� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � /202-2� -c�4 <br /> OWNER ADDRESS CITY2IP PHONE L�� ; ^3�d ��L <br /> In/����:/(.:/� ,Se �yr !�,_�� /c�,�ia.�Y; .�,�<., .;,2c ?—/c �i �l. 5: �:. CuPi'.E:r� ��y£i.'i�Pl <br /> TENANTNAME � `I CONTACTFORPERMI7 � PHqNE <br /> r <br /> � .�i��.t('.. .5 .'���7�f'.. � � � ��� <br /> CONTRACTOR .5�,����� � ADDRESS CITY2IP PHONE <br /> � . � . <br /> CONTR.LICENSE# - � � �', �.- . . � <br /> �A��I vc"�'� S C� ii,�!"1 (.. . .. • <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,S �': c - <br /> Eleclric �–Gas Other <br /> WORK DESCRIPTION ���� /�� <br /> PLUMBING MECHANICAL <br /> NO. ZYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 5 Toilet — A!C–air handiing units <br /> � Bathlub / Forcedairsystems <br /> �1_ Lavarory(wash basin) �-/ Gas piping <br /> _ �: Shower � Waterheater <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> / Dishwasher — Gas range <br /> % Clothes washer � Clothes dryer <br /> --" Laundry tray _/ . Range hood <br /> � Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backflow preventer – Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> — Grease trap — Woodstove <br /> Roof drains Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The c�ranting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrectors Law 1A.27 RCW and 296.200 WAC. <br /> ��i< -7'f� /�C-L.�..�n� _,�r � !1•� <br /> Signature of OwneNConVactodAuthonzed Agent ate I <br /> I \ <br />