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P�R�11iIT A�'PLICATIC�N <br /> CI i Y OF E'JERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FF,X 425-257-8857 -www.everettwa.org <br /> AF'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> _ r�.,<..� - C �r^r. o�o� 1%7/2 C'�OI <br /> LEGAL� LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> oesc. „� � .. , Y,,�c t.1= 4 a 1 00'�n�t 3-S�o3 - ���i�:�3 -05 <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> , , , _ ..., ,- � :�.-. �Po $ox 2�-St� �veare-N ��i213 31�0 lnl�g(��-13 <br /> TENANT NAME CONTACT FOR PERMIT P ONE L�'� -�s)L�.��� <br /> T��"1� E-MAIL"YU1�y���.\��'�'-(JV'1CISe•Y� <br /> CONTRACTOR A�DRES CITY/ZIP PHONE- T— <br /> �1Y'o� {�hGSt CAI?5�' �1'`(. �NVNP QS owney' <br /> CONTR. LICENSE# <br /> F� ��-1-�1, �`a�C.M <br /> USE OF BUILDING HEAT SOURCE CONTRP.CT PRICE OF WORK <br /> Si��=c.vv� �r'es�den�e y Eie�<<�° _c ,_o�ne� l35 oorJ ° � <br /> WORKDESCRIPTION r.. `-r,.�., ; �„ .: , :,ie1..s-•••e.•c: <br /> rn��, .,�. . : r�. , . .. :"1."r�� ir`. •.u�.n�' . . . <br /> •tiN <br /> 4ta•1 t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C-air handling units <br /> 2 Bathtub Forced air syslems <br /> 1� Lavatory(wash basin) Gas piping <br /> � Shower � Waler heater <br /> l Kifchen sink& disposal _ Gas(ireplace �i <br /> 1 Dishwasher Gas range <br /> 1 Clolhes washer � Cloth�s dryer <br /> Waler healer 1 Range hood <br /> Sink(scrvice/bar/mop/etc.) � Exhaust fan <br /> Backtluw preventer _ Heat pump <br /> Urinal Unit heater <br /> Grinking Fountain _ Boiler <br /> i Floordrain Refngeration <br /> _ Grease lrap Woodstove / � <br /> Roo(drains � Olher i I/ Q(� <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify lhat I hav�read and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing lhis type o(vaork will be complied with whether speci(ied herein or r�L The granting o(a permil does nol presume <br /> to give authority to violale or cancel lhe prcvision of any other state or local law regulaling construction or the pedormance of <br /> construclion.That I am authorized by the ov:ner of this property to perform the work for which applicalion is made and I comply wilh the <br /> Slate Co�dractors Law 18.27 RCW and 296.200 WAC. <br /> . i;< : s aoo� <br /> ��ynature of OwnedConlractor/Authorized Agent Date � � � <br /> � ,��'h�o� ,�� <br /> — - -- , �y�. <br />