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PE MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEI. TAX I.D.# PERMIT# <br /> ��IS .�.}�, d(�5747oo101Go! I -1�/ <br /> 9� � LrS�- 3���WHC SKIIGID� / <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. vu � � , <br /> OWNER ADDRESS CITY2IP PHONE <br /> LL�',21niaL SCuAKc.r2�uUzfn�rr�f. I?J.�o�c (�SS SrvoHomisT(�W/148aJd� <br /> TENANT NAME CQNTAC FOR PERMIT pHUiJE <br /> LrNGAGING MJNDS I S�Ry ,D�SGZ�e't, '-/15-7�4��Fjj3�kl <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CSG�//Y�PiG MG'G�ANi�,LS/VC. 217t66l.t"AV[.'.U�.ao7� H�Tluq• 9Boy3 �/1i=77`�-'���4 � <br /> corfTR.LICENSE# <br /> n �"Y/�Pmt � �0�1 <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> p�'�7CLf � ��I AI L I _Electric ,�Gas_Other ����� <br /> WORK DESCRIPTION � <br /> ('R�v�o� i ,���r' To yTo,v Nu/e� uN�� c��rH 44su�F�r�� tR�TtiwJ��RJ o,vc-°' ,e�R.�or� <br /> �RNJ AI.A�D yA5 �lF'/�uG l e ! AppGlcfaluGE <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet I A/C—airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash Lasin) � Gas piping <br /> Shower Waler heater <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 Founlain Boiler <br /> _ Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALEg SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this appllcaGon and know the same to be true and correct. AII provisions of Iaws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating constructlon 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 ontractors Law 18.27 RCW and 296.200 WAC. <br /> �'`� � L� �/Z <br /> Si ture of edConh todAuthorized Ay4nt D e <br />