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� <br /> t <br /> PERMIT APPLICATION <br /> GITY OF EVERETT PERI"JIIT SERUICES <br /> 3200 CEDAR STREET, EVERETT,WA 982('1 <br /> 425-257-8810—FAX 425-257-8857—www.everef�wa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM �� '" �y D� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT X <br /> 11�119 I� �lvs S� oony�oolol�ol � ��7� c - c�3 � <br /> LEGAL LOT NO. BLOCK TAACT OR SUBDIVISION N <br /> DESC. �� (�O� <br /> OWNER ADDRESS CITYlLP PHONE <br /> pu�n¢niN �nev�oPra�nfT �po.�ox roS9 Snlorfor+UH 9ez�! y25-33�I-S�18 <br /> CON'PFkrI�I <br /> TENANTNAME COHTACTFORPERMIT PHONE 425-3��7^��� <br /> SI�vE1Z1.A� usED �oo�srotZ� I GhV�TAL A1ZChF�L�1S INC ���ylGtvc.I�t��t�-FS <br /> CShND�A At,�ER-� EIAAIL@�.V-{'1����^k•✓�'�� <br /> �u��-w�T CoNs7RucTIoN 'P.O. Bo�c '.+33T q�U�v.7a�/ µ2S- 29o- 9�4C, <br /> CONTR.LICENSEM'�(�^�wL �g��G 982i3 <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �po�Sl'D� I _Electric .�Gas_Other � 'Z� OOU <br /> I <br /> WORK DESCRIPTION <br /> l��cc.ar� hN sxi S�r-i�lG y✓q��� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> O Toilet o A/C-air handling units <br /> o Bathtu6 Forced air systems <br /> Q Lavatory(wash basin) Gas piping <br /> o Shower Waterheater <br /> O Kitchen sink&d!sposal Gas fireplace <br /> O Dishwasher Gas range <br /> O Clolhes washer Clothes dryer <br /> Q Water heater Range hood <br /> � Sink(service/bar/mop/etc.) Exhaust fan <br /> O Backflow preventer Heat pump <br /> Q Urinal Unit hea�er <br /> Q Drinking Fountain Boiler <br /> Q Floor drain Refrigeralion <br /> O Grease trap Woodstove <br /> _Q__ Roof drains _ Other <br /> � O�her — <br /> CITY OF EVERETT LOCAL SALES TIU(CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be irue and correct. Ail provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whether specitied herein or nol.The granting of a permit does not presume <br /> to give authoriry to violale or cancel ihe provision of any other state or local law regulating conslruclion or the pedormance of <br /> construction.That I am authorized by the owner ot this property to pertorm the work for which application is made and I comply with lhe <br /> State Contractor�lari 18.?7 RCVI�and 296.200 WAC. <br /> �_; � �f,� ` <br /> �il , ��i PO �� �� �� <br /> Signature a ivnedContractor/Authorized Agent Date �,�, <br />