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�r- - <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE MDRESS PARCEL TAX I.D.# PE I # � <br /> , , , ia� r� � � UgoSI o0 0 o a� � <br /> LEG<' LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> L''oAS�PrI.. 5'F��-loE q bttl S. 2�10 51-. SwiEiIS ¢z5 ) 45z - ri'4ov <br /> _J l� /+R-TNE SH� �(AKIMA wq • 9 $ � B <br /> TEN/:"r1T NAME�//�,� h'�., � �'j�/�-�. i77�'� CONTACT FOR PERMIT PHONE <br /> _ri«� "" I <br /> MR, Ki��� . 7o�6� Su�4% � `(ourib Kiw1 206� 355 — q 686 <br /> CONTRACTOR �-R � ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> !JSE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> `.iNoPIN(� P'�A�i.- {ZE-ST7FU(L!}N� _Electric �[Gas_Other �G�C� <br /> WOR{�ESCRIPTION <br /> 'fl tEN�-n�r I M r�o YE n�r � n�r � � le.� to H �4V� �g- <br /> r� �i Y�-�� ► !�� s ��,�.�-►.:► r <br /> PLUMBING MECHANICAL ��;XI S'j' <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> -� Bathlub Forced air systems ' <br /> 1�� Lavatory(wash basin) Gas piping <br /> - ower Waterheater <br /> 2 i en smt�8 disposal Gas fireplace <br /> _ Dish her Gas range <br /> • Clothes sher Clothes dryer <br /> 1 Water heat�r [2ange hood <br /> � Sink(service/ /mop/etc.) - E�ehaustfan <br /> � BackFlow preven F'e pump <br /> Urinal �nit aler <br /> D:inking Fountain Boiler <br /> J_ rloordrain _ Refrige ion <br /> _ � Grease lrap Woodstove� <br /> =I Roof drains Olher �. <br /> Other = <br /> CITY 6F 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 governing lhis lype of work will be complied wilh whether specified herein or not.The granting of a permil does nol presume <br /> to give authorily lo violate or cance�the provision of any other state or local law regulating construcGon or lhe per(ormance of <br /> construction.That I am authorized by the owner of lhis properly to perform the work for which applicatlon is made and I comply with the <br /> Stale Conhactors Law 18.27 RCW and 296.200 WAC. <br /> �p U�9 -7 C-�-�� �2�� o�� <br /> SignaWr of OwnedConlractor/Au�hori ed Agent Dab•7 <br /> �/,J I <br /> —J <br />