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� PEF.�VIIT APPLICATION <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 - DEBIT &CREDIT CAROS ARE NOT ACCEPTED <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT# � <br /> � � � ��� A 'z f � IOv � 5��—/ <br /> LEGP. LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> •Shcu�r,i� �ctt��c- 1141 1 I�� {4UL. �� E��i�-}�- I��A �b'o103 y1,�-2�t'i-.5_S['7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> L�los��- .Sl��i e 1� (-i�u�k �o�,�t� I�tS '�2S-33o • JIUD <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> i�[��7 5ic�n tic��v�ce� i�aia Pw4��11-G�cki� M��y ��:�}e �13� M�IIC��d�, ��A �iKai2 Nzs-3�e-ai�o <br /> CONTR.LICENSE# <br /> RfirSI��:�i9cr�: <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> IU Ft- <br /> �\r,��,i � I _Electric _Gas_ er ��71�, r`�� <br /> WORK DESCRIPTION <br /> I1�S��c��� Gi'� �)�i,i�v�.� �t�-��-ei^ �.������i�� C-'i'l 1'�Cr i,�a� . <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas frep�ace <br /> Dishwasher Gasrange <br /> _ Clolhes washer /�' Clolhes dryer <br /> Laundry tray � Rar��e hood <br /> _ Sink(service/bar/mop/etcJ Exha�isl fan I <br /> Backilow prevenler Heal pump / <br /> Urinal ' Unit healer � <br /> Drinking Fountain Boiler <br /> _ Floor drain Refri�eration � <br /> Greasetrap Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same lo be true and cortect. All provisions of laws and <br /> ordinaces goveminc�this type of work will be complied wilh whether specified herein or not.The granting of a permil does not presume <br /> lo give aulhoriry to violate or cancel lhe provision of any other slate or local law regulating consWction or the pedormance of <br /> construction.Thal I am authorized by the owner ot lhis property lo pedorm lhe work for which application is made and I comply with lhe <br /> State Coniractors La ��RCW and 296.200 WAC. <br /> ���� � � � � / �> ��_. <br /> Signature o(Owne lraclodAulhonzed Agent Date <br /> �Z <br />