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PERMIT APPLIC�4TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-�nnvw.everettwa.ora <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br /> SITE ADDRESS PARCEL TN(I.D.# PERMIT# <br /> �/� f�, s ovy 9 7i o0006�0/ �,�u �X- D Z�, <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION It <br /> DESC. <br /> OWNER ADDRESS CITY2�i' PHONE <br /> Ale� C���� s Z7/ip .��'' .�i �v�rrff 9�Zo l ! <br /> TENANT NAME CONiACT FOR P RMIT PHONE(/�'3�O'7 �SS/ <br /> �rt y /Lo�41r11.L / E-MAIL ION�/ ��f�G4�SC'/'di«S_ �� <br /> C�IJTRACTOR ADDR CITY/ZI PH NE <br /> ��a)� i�,c �rn��l L�,r��c��,� �D Qo.X llZ 1 Mtv y svi/,E. �L�o �IZS s'�7�SS l <br /> CONTR.LICENSE# /]��a2��/7 y� p/ ). n p <br /> rlw 1 �f /l04 f— � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Other <br /> WORKDESCRIPTION n �,o{` ����Ac�,,,H�f 2GrNC01.I a Q;��rocn: -- U"�f` LnyrK� u��k1 <br /> t'- � <br /> �;�� n_ .-, <br /> � �IS�t IK�, Vn�,i�q , Tile-l- /{{SII ��-{i,/ -, Qc�l�c1.c .fti�r,>rr, lGile-f. �' y <br /> 7V�w / IHI7�UIL'1% �S 1���.t'SSN �O RLG.[1N.'N�c(%7G Nt.h7 �J��N/Yf <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF f-IXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> 1 Bathtub Forced air systems <br /> �. Lavatory(wash basin) _ Gas pipiny <br /> _�___ Shower _ Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwashcr Gas range <br /> Clothes washer Clothr.s dryer <br /> Waler he�icr Range hood <br /> Sink(service/badmop/etc.) � Exh;�usl fan <br />' �ack�low prevenler _ Heal pump <br /> Urinal Unit heatcr <br /> Drinkin� Founlain Boiler <br /> Floor drain _ Re(ri�eralion <br /> Gmase trap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined lhis applicalior�and know the same to be irue and correcl All provisions o(laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specilied herein or nol.The c�ranting of a permil does nut presume <br /> to c�ive aulhority lo vinlate or cancel the pr vision of any olher state or local la���regulaling consWclion or Ihe performance of <br /> construciion. Thal I am authorized by the wner o(this properly to per(orm the work for which applicalion is made and I cumply wilh lhe <br /> Stale Contract rs L� 18.27 RCW and �G.200 WAC. <br /> � -�- , �/a �%� <br /> Signalur� vi er/ onlraclor/Aulhorized Agenl Dale I/ <br /> Z <br />