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i <br /> PERMIT APPLICATION <br /> _ � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEp FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITEADDRESS 12728 (3o�'h2II � PARCEL':AXI.D.# PERMITR <br /> E,,.,,e�( Nw 28053000Hoo � oo �Ci;-Gh 0U5 <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER r f ADDRESS CITYIZIP PHONE <br /> �v���ei5 �'�1�[-aTment �jYO�P <br /> �1 <br /> TENANTNAME I CONiqCTFORPERMIT PHONE <br /> C qONi�CTOR�� a A�DRESS CITYIZIP PHONE <br /> �N f"1 1-,;c, ��3z1 rtyc Sl s�C-�Q M�.,.o� 4827z �Go-�9�1-BGzI <br /> CONTR.LICENSE It W OLF���'��Y O� _ <br /> USE GF BUILDIhG HEAT SOUi:CE CONTRACT PRICE OF WORK <br /> � ��G�, — Q _Electric ,_Gas_Olher <br /> WORK DESCRIPTION I <br /> � (�e5�y✓� l �v�Sltl�l nein/ �vl�w�ahc. SPri��C��e� 5�5�2w1 O� r <br /> Ni=Pa 13 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. 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 healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodsto�v.e � � �� 1 <br /> _ Roof drains �C�i Olher. _���M�rr� P$ <br /> Other � <br /> CITI OF EVEREIT LOCAL SALES TAX COOE IS 7105 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and wrrect. All provisions of laws and <br /> ordinaces goveming lhis type o(vrork will be complied with whelher specified herein or not.The granting of a permit doe>nol presume <br /> to give authority tu violale or cancel the provision of any other stale or local law regulating construction or the�edormance of <br /> wnstruction.That I am authorized by the owner of this property lo perform the work for which application is made and I comply with the <br /> / ate Co clors L..w 18.27 RCW and 296.200 WAC. <br /> l , I <br /> j � �/V . <br /> j Signalur Owne / ontractodAulhorized AgeM � Date � <br />