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\ <br />/ <br /> P�.r2MIT APPLICATI�inl <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS rt PARCEL TAX I.D.# PERMIT# <br /> l/o/ 9 ' C �yDoyov I (� s�3 -� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. �C ,Q-I�AC�ed <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �o�stA L s en lao� �o.�o,c �3 5 V�k�wu} g� y cn t s�y� ��l3-yes� <br /> TENANT NAME CONTAC7 FOR PERMI PH NE <br /> CAM bc�(-1 s �r�uc.= �N I r� W�I So►� Cyls') 25 2 -Syc� <br /> CONTRACTOR (�� 'gqQ���/NL. ADDRE55 CITY2IP PNONE <br /> CONTR.LICENSE#��Wgprt� Qoyy2P ��.f3ax �g2B ,SN��OYNLS�S /�F���yZ��7'y2y7 <br /> USE OF dUILDING ( — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 17r�U4iN �5}. Eiectnc Gas Other <br /> WORK DESCRIPTION <br /> �-e�4 I' CYaC-u�1 l� U � �C�/IJ� <br /> • PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR 1TEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Furced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry Vay Range hood <br /> Sink(service/bar/mopi=.tc.) Exhaust fan <br /> Bac4;flow preventer Heat pump <br /> Urin,al Unit heater <br /> Drin<ing Fountain BoJer ! <br /> _ Floor drein Refrigeration I <br /> _ Grease trap _ Wnodstove <br /> Roof drains Other � <br /> _ Other _ j <br /> CITY OF EVERETT LOCAL SAIES 7AX CODE IS 31D5 I' <br /> i I <br /> I hereby ceritify that I have read and examined this applicatlon and know the same ro bs true and correct. All pravisions of laws and j <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not pres�me <br /> � to give authonty ro violate or cancel the provision of any other state or local law regulatlng consWcbon ar the perfortnance of I <br /> � construction.That I am authorized by the owner of this property to perform the work for which applicatlon is made and I comply with the I, <br /> � State Contractors Law 18.27 RCW and 296.200 WAC. I <br /> �Y/ �l�io., ��y�h r <br /> Signature o Owner/Contractor/Authonzed Agent 6ate I <br /> I <br />