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. <br /> n <br /> � <br /> — — --- <br /> I PERMIT APPLICATION <br /> iCITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SRE ADORE55 ! ?A.RGEL TAX I.D.# PERMI7# <br /> I I�12ti � 'ri'1 ,/�-(1� . � � � _ - L <br /> LEG LOTNO. BLOGK TRAGT <br /> DESC. <br /> OWNER AODRESS CITYTP PHONE <br /> Yv1il',l�ael Wt�i���1� �e c( �=���- �J25� 7,�� �33� <br /> TENANT NAME CONTACT FOR PERMIT PMONE <br /> �l�1�111�k1r� ( V1G I�GiYu�- ��,I�f I�s �-/Z5� g 9�- C39S <br /> CONTRAC OR �J.� � DII�I-t� �� � ��7�t' ADDRF,53 CITYZP PHONE <br /> (' aP�u ���I��� 242�1 2'�3r�I ��� �i �►I �g �� �9�0�1��3 <br /> CONTR.UCENSER A <br /> � _ li <br /> USE OF BtlIEGMG G��(j�? tIEAT SOURCE CONTRACT PRICE OF WORK <br /> �I�j�� ,� Q _Electnc _Gas_Ofher I � ��L�, — <br /> WORK�ESCRIPTIO <br /> cavrcct �l�E�r�l�ir�� oft�v��e i��� ��ery�i{� <br /> Pi.UMBING MECHANICAL <br />� NO. RE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Toilet A!C—air hand�ing unRs <br /> eathtul� Forced eir systems <br /> � I.avatory(wash basin) _ Gas plping I <br /> Shower Water heater <br /> Kltchen sink&disposal Gas firepiace ; <br /> Dishwasher Gas range � <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(semce/bar/mop�etc.) Exhaust fan <br /> DackBow preventer Heat punp <br /> Urinal Unit healer <br /> Drinking Pountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstwe <br /> Roof drains Other <br /> � ome� �al��� 5�'��4� — <br /> ( <br /> Cf7Y OF EVERETT LOCaL SALES TAX CODE IS 710tl I <br /> I hereby ceritify thai i have read and examined this applicalion and know ihe same to be We and arted. NI provisions of laws and �, <br /> ofdmace5 goveming this type ot work will be Complied vnth whe[her spednetl hereln a not 1Te granUng of a permit dces rxH presunre <br /> to give authonry lo violale or cancel the provision of any other state or local law regulatin�consUuction or tfie perbrmanco of <br /> consW�ion.That I am aulhorizetl by the owner of Ihis property to perfomi the work fcx whiUi application is made arxl I compiy with the, <br /> Stale Contractors Law 10.27 RCW and 296200 WAC. <br /> �'i�=? —S �c-'�r'�%%, '���-�� <br /> Si ature of O�nmerlConhactoUAuthonzed Agent Da[e <br />