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/ <br /> -- � �' — <br /> PERMIT APPLICATION <br /> CITY QF 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 <br /> SITE ADDRESS PARCEL TAX I.D.# P�ERMIT it <br /> I 1525 19rth e. SE S�C �� 9b' � I IS �� � � � 3 �-- <br /> LEGALI LOT NO. BLOCK TRACT <br /> DESC� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> M�r.l�c��i W�-io�h�- 11525 (�fn°�'e. S� Evere�-� �1�20g ���3qz� <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> �!1 1V'1�/ `7�'�YI I II VIIrvIV TIiL�}7J Z5 � 337� � <br /> CONTRA OR DDRES`S/ CITY/ZyIP PHONE <br /> CONTR.LICENSEp I� � f� .� �Y � I�����lt'��I y V V �� ��� I �'� d5�� 7 3 I � 733j <br /> ,i <br /> USE OF BUILDING — VRYI�'e HEAT SOURCE CONTRACT PRICE OF WORK <br /> U y� �°f ��'�- �a,IBn w G�Ay SY� _Eledric ✓Gas_Other '/ lYl <br /> I � �`t � • <br /> WORK DESCRIPTION <br /> �4-�1d s)��1-ack , G(ry�v�Ill. �F-il� ���iuY s�'7��s � {�c1 �1Yle S'VIfliM,t' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> � Shower Water heater <br /> _ Kitchen sink 8 disposal Ga=,Frep�ace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clnthes dryer <br /> _ Laundry lray Ranye hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> _ BackAow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETf LOCAL SALES TAX CODE 1S 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be We and correcl All piovisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violale or cancel the provision of any olher stale or local law regulating construction or ihe performance of <br /> construdion. That I am authorized by the owner of this property to perform the work for which application is made and I comply wifh the <br /> State Cbntrectors Law 18.27 R�and 296,200 WAC. <br /> /.ii,'.;; G.'�-.. � 1:� ;�u/� /G:7�/G'� iicaY S/�r�Vd�" Sk <br /> SignaWreof wnedContractor/AuthonzedAg n Date �v�,,tyf� ecq 9���'f� <br /> � <br />