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r_ _ __ ' <br /> P�:RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-H857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. A I PERMIT M <br /> lya.7 loo�' sr, sw. '���' �oy�'1 -aay -Qo8 -oe CoS�U -�OS <br /> LEGA LOT NO. BLOCK TRACT �_-�.r��� <br /> �ESC. �A W I�I `��TTES IYIO�1 t� QR'R�C <br /> OWNER ADDRESS � CITY2P PHONE <br /> MIKE HRIl- �Yz7 rao� S� . sw Ev�7'r yzs-.ss3 -9yY% <br /> TENANT NAME CONTACT FOR PERMIT Pk10NE <br /> �B ¢ F�RA REFLrN6 BREavr W pt-KER y25�qo-95a� <br /> CONTRACTOR �r�/p/�ER CON67T���ADDRESS 7y'J..t/ lBROROW�{.CITY2IP PHONE <br /> ST2.A E✓6ItEr'� WRSH `/26-►�-9t�-4Sd/ <br /> CONTR.LICENSE p WA�-15EC.�' 1 I ZK�- FXP. o�'��'a�7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRoICoE OF WORK <br /> S F R �Electric _Gas_O�her � !O�000 • <br /> WORK DESCRIPTION <br /> ��GTR� �4 NF-W ri�HNu,FAC-Tu�C-D l-{ewt-E <br /> PLUMBING MECHANICAL <br /> NO. tYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURG OR I i'EM <br /> Toilet _ A/C-air handling units <br /> Balhlub _ Forced air systems <br /> �_avalory(wash basin) _ Gas plping <br /> Showor __ Waler heater <br /> Kitchon sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washor _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(serviceNar/mop/etc.) __ Exhausl(an <br /> BackAow prevanter __ H�3a1 pump <br /> Urinal _ Uni�healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeratlon <br /> Groase trap _ Woodslove <br /> Roof drains _ Olher <br /> Olhcr — <br /> ^ S/L� — <br /> -t-c <br /> CITY OF EVEREiT LOCAI SALES TAX CODE IS 3/05 <br /> I horoby ceritify tha�I have read and examined this a{�plicalion and know Ihe same to be true and correct. All provisions of laws and <br /> ordinacos governing this ty{�o ol work will be complied wilh whelher specifiod herein or nol.The granling ot a permil does nol presume <br /> to ;�ivo aulhonty ro violale or cancel Ihe provision ol any olher staln or local law regulating construclion or lhe peAormance ol <br /> conslruction.That I am aulhorized by lhe owner of ihis property lo peA�rm the wurk lor which applicat�on is made anA I comply with the <br /> Slate CoMractors Law 18.27 RCW and 29fi.200 WAC. <br /> y._%� -�- g -�o-os %� <br /> Signature o OwnodCoNractorlAuthonzed Agent Date <br />