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i <br /> , - � <br /> � <br /> PERMIT AF'PLICATION ', <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857-www.evereriwa.orc� �� ` � � <br /> APPLICA7�UNS ARE ACCEPTED FROM 8 AM'(O 4 PM - �EBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> io53o iyTM Q�E SNoq�/Z733 ' <br /> — i <br /> LEGAL LOTNO. BLOCK TRACT � i <br /> oesc. 2 Z S�tv�2 �dkF �ARDFN <br /> OWNER ADDRE55 CITYZP PHONE � <br /> ItOJ AND MdRI wu KEPptt�Z 37/y /OBT^` SF �ve�Lc7l y8Zo8 4�25, 337.v32S <br /> TENANT NAME � CONTACT FOR PERMIT PHONE � <br /> N/4 kvAN L3o��qniy�R z53. z6'�. 3465 � <br /> I <br /> CONTRACi'OR ADDRESS CITYIZP PHONE � <br /> PQTIZIDT F/2= I�20TECr/ON z707 7or�+'�VE F TACc�Mel z53. 9Z6.ZZ90 � <br /> CONTR.LICENSE# yS4Z�F <br /> ➢ATR 1F�99�F ' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> OfF/C t I _Eledric _Gas_Other <br /> I z� gs� �� <br /> WORK DESCRIPTION <br /> /NITALL �12E SPRIN�dE,2 SYSTEM �N NE�u Bw�D/N�j �tR NJr'f�I /3 STANpQR� <br /> � <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM � <br /> Toilet A/C—air handling units <br /> BsthtuL _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> Laundry tray _ Range hood <br /> _ Sink(servicelbar/mopletc.) _ Exhaustfan <br /> Ba�kflow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains __ Olher <br /> =I Other <br /> 9�f F� c. S�'RINKESRC <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state ur locai law regulating construction or the peAormance of <br /> construction.That I am authorized by the owner of this pr�perty to perform the work for which applicalion is made and I comply with the <br /> State Contracl4rs Law 16.27 RCW and 296.200 WAC. <br /> /!" I���-____,, �IZS��S � <br /> Signature of Owne ontractor Authonzed Agent Date �'� I <br />