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SITE ADDRESS <br />��� y <br />LEGAL� IA4 NO. <br />DESC. //��'T�j <br />PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, EVERETT, WA 98201 <br />425-257-8610 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� I��- D <br />�'1 C.od!_'r S E s <br />BLOCN TRACT <br />Z� <br />PARCEL TAX I.D. # PERMIT tl <br />sosi�'on9n3yoo l'. �'lni�" �'� <br />�nSf �fiA.f,�S �NC• // 7n 6 i�//lLi�NL <br />TENANTNAME <br />CONTRACTOR OSL= <br />CONTR. LICENSE p <br />�C�ONTACh FOR PERMIT <br />K,s�e KCoy N/ <br />A�/C-S ADDRESS �'//-�y� <br />asE /! I. *Oy��z— <br />u ✓, //E 3Gr - � sz- �s9j <br />PHONE <br />.JG-lT�rs 3G�n-Gsz• 7s� <br />CITY2IP PHONE <br />USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br />�. F �. _ Elecldc �as _ Othor <br />WORK DESCRIPTION <br />[ 6n/Si /�[!Cr/�C�✓ b% •Q'�'�- SiNq�L F/M1NIi�1� le�•`s/DL''��'(L� C��IS�� ���Z� <br />NO. I TYPE OF FIXTU�2E OH ITEM <br />y� Toilal <br />�' Ba'htub <br />� Lavatory (wash basin) <br />I Showur <br />1_ Kilchen sink 8 dis{�sal <br />! �ishwasher <br />f C�oOies washer <br />L Wator heator <br />- Sink (s�rvice/barlmoplr.tc.) <br />Backllow prevr,Ner <br />Urinal <br />- Drinkinc� Founlain <br />- Floor drain <br />-� Grease Irap <br />Fioo( (�f0ills <br />-' OIhC! <br />NO. I TYPE OF FIXTURE OR ITEM <br />'—' A/C - air handling units <br />� Forcod alr systoms <br />3 Gas piping <br />_�_ Walorheator <br />-� Gas liroplaca <br />�_ Gas rango <br />� Clolhos dryor <br />_L Ranc�e hood <br />,� Eahauslfan <br />.�. Heat pump <br />-^ Unil healor <br />^ Bollar <br />�- Rofrigoration <br />� Woodslove <br />^ llthnr <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritily lhat I have reaA and ezaminr,d this application and krn�w the sama tu be lrua and rorrecL All piovisions of laws and <br />ordinaces governing ihis type ol work will bo complied with whethor spocifiod herein or nol The granling of a permil does nol presume <br />lo give aulhorily lo violale or cancol ihe provision of any o�her slato or local law rogulating construction or lha performance o( <br />construction. Tnal I am authorizod by ttio ownr.r of Ihis propoAy lo poAorm Iho work for whlch application is made and I comply wilh the <br />SI �lo Contractors Law 18.7n1 RCW and 296.200 WAC. <br />/L'N• /i � /1""E <br />Signalwo ol OwnodConlracl <br />