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� <br /> P MIT APPLICATION <br /> CITY OF EVERETT PER�JIIT 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 8 CREDIT CARDS ARE (JOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � 1 � V� `aG �P�D` � 1 � . <br /> LEGA LOT NO. BLOCK TRACT � I <br /> DESC. ` <br /> OWNER ADDRESS CI7Y21P PHONE <br /> o,rine� Sr� ��n.rP. -I tVues�me�t�- (•b �ox 105� Sro�rvm�sh 9�2q1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �Ush� �.�r,0. �ecY'� ��Z��e� t125•��N-£�dul <br /> CONTRACTOR p�y,�.,�,��G ``�e���`�1 ADDRESS n CITY2IP PHONE <br /> 21'1 l f� �.¢�v ./�� � <br /> CONTR.LICENSE# <br /> O�YMPP��-0020L� f1ou„k�r,,kc. T�e�rUce ggoy3 y2s-���i-�,B�11 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 'R����\ _Electric �Gas_Other �—� UQ� <br /> J ` <br /> WORK DESCRIPTION —�^���\�,��� �' 1 ��I EICCI _�G y ��t1 }�U��i UY�+t� <br /> .1— T'! <br /> I e��i.�sk �'o�n � u s�qpl•� rur�s, 1 rek�rr� o:�r . Gu.S p�p�r�r� � <br /> 3 �''�X�l�t`2S• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> 8athtub __(._ Forced air systems <br /> Lavatory(wash basin) �_ Gas piping <br /> Shower Water heater <br /> Kitchen sink& 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 /> 6ackflow preventer � Heatpurnp <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodsrove <br /> I = Roof drains _ Other ' <br /> Olher <br /> i <br /> CITY OF EVERE7T LOCAL SALES SAX CODE IS 3105 <br /> , I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions of laws 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 aufhority to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by Ihe owner of this property to perform the work for which application is made and I comply with the <br /> ' Stat tractors Law 18.27 RCW and 296.200 WAC. <br /> i V^�� , <br /> Sign re of 0 r/Contractor ihorized Ayent Date / <br /> i / <br /> �� <br />