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Fr;RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERI_FT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PMyJ-11 j•L, <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT N � <br /> LEGAL LOT NO. LOCKTRACT <br /> DESC. ' P�(aIfPf 0K. V 0- /1?0a <br /> OWNER ADDRESS CITYIZIP PHONE <br /> t' <br /> 111 wa4..ltau,,._ '�Ta���..n.->4� '•�1�La Y7,2.O...� ra L varxl�-t 94?or �I <br /> TENANTNAME CONTACT FOR PERMIT � Kpp� PHONE <br /> CONTRACTOR ADDRESS CITYIZIP PIIONE <br /> Ik&a-%q- tial.. �igu37Ll_( (Te�ia �5��(aue.3t 3o��rU 4'rtt� q� s •113 <br /> CONTR.LICENSE If 1-1 1 $ <br /> —1 .. - L(.i'5�� 1 <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric ,ZGas_Other <br /> ( •iol moo,;. <br /> WORK DESCRIPTION f 1 4 w Jv At cL u�Z' 0.L O - 13"aAL 'Z C$ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Tollcl A/C—airhandlingunits <br /> Dathlub 1 Forced air systems <br /> Lavatory(wash basin) Gas niping <br /> _j_ Shower I Water healer <br /> I Kilchon sink A disposal Gas fireplace <br /> 1 Dishwasher I Gas range <br /> I Clothes washor I Clothes dryer <br /> I_ Walor hoalor I Range hood n wt o <br /> _(_ Sink(survice/har/mopinlc.) 4_ Exhaust fon <br /> Backllow pruvonlor __ I loot pump <br /> _ Urinal _ Unit healer <br /> _ Drinking Fountain _ Bollor <br /> _ Floor drain _ Refrigeration <br /> _ Grease Imp _ Woodslove <br /> _ Roof drains _ Other <br /> Olhur ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby corilily(hat I have road and examined this application and know the same to be true and correct. All provisions of paws and <br /> ordmicos governing Ibis typo of work will be compliod with whuthor specified heroin or not.The granting of n ponnit does not presume <br /> to give authority to violate or cancel the provision of any other slate or poral law regulating construction or thin porhof mance of <br /> construction.l hat I run authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Conlradois Law 10.27 RCW and 200.200 WAC. <br /> ''l.l a ori o•t <br /> Signalurn nl Ownr.:ICuntmrind dhorized Agent ala /l <br /> o` <br />