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�sn� — 1 �i3 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />q��o �ar.�, C4.�e,. s,� <br />LEGA LOTNO. BLOCK <br />DESC. <br />OWNER � <br />ry� l KMrtInlllMlfdd'�(],An <br />TRACT <br />PARCEL TAX I.D. # <br />� <br />°RMIT # <br />(00� � 2O <br />TENANT PIAME, • CONTACT FOR PERMIT <br />L��u� NQ ,N�e PHONE <br />.�,�$l,�O.-�-�"`i`�'���'s'° �'�w� �ope�' �-IQOS-8� <br />CONTRACTOR ��.,` ADDRESS CITYIZIP PHONE <br />U <br />CONTR. LICENSE I! <br />USE OF BUILDING <br />HEATSOURCE <br />✓ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />�� l.lQ6N`PJ�.P�4 ��`n-� O-V�.- <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dispcsal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backfiuw preventer <br />Urinal <br />Drinking Fountain <br />Floordrain <br />Grease trap <br />Roof drains <br />Other�_ <br />CONTRACT PRICE OFOWORK <br />I �, 2oO � <br />��%�.�v\\� S `�.Q �"�4�� <br />N0. � TYPE OP FIXTURE OR ITEM <br />A/G — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other�jZ��_ <br />CfTY OF EVERETT LOCAL SALES TAX CO�c IS 3105 <br />I hereby ceritify that I have read and examined this application and know the sarr,e to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether speci��ed iierein or not. The granting of a permit does not presume <br />to give authority �o violate or cancel the provision of any oiher state or local law regulaling construction or the performance of <br />con;.truction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contrectors Law 18.27 RCW and 296.2C0 WAC. <br />: " ----, <br />� � 4 Zj O� <br />SignatLre of Ow ntractodAuthonzed Agent Date \'�� <br />/ <br />