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• <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERErT, WA 98201 <br /> 425-2.57-8810- FAX 425-257-8857-vAvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 — ) —°S <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3 000 P K c-Lc' - 71--40o iv cg 1c-&%0-1 -CL-5 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER, ADDRESS CITY2 P PHONE <br /> SHcp/f ' s—I/ coc.c,&cTr 3000 P cic&Fv- vc. s 2$0 '"fo f`f-.e..5 3ft-13�'j <br /> TENANT NAME I CONTA,,�T FOR PERMIT PHON Z. - �7'(/ ?i-6' <br /> leiti [.�6,' f. �i-I Koh•(nov'dort�ricile dl,id 4, <br /> E-MAIL)' <br /> CONT ACTOR ITTEP <br /> ,, y7_ ADDRESS CIEP H <br /> CONTR.LICENSE#e Y,Z.$ �. r�-2'i l J•;[C G <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f' I,II LT:A t./ZT 6c p -Electric Gas Other r �n �— <br /> r•1•Yi XL RIWORK Glome—f._ A17'1462 ArCG� DOM- 7?") f—N ` Tt.[�O r�//^�C.£f <br /> 61,4T afe-ii15-7 /s-7- r-°on- AC-traX7- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ToiletAIC—air handling units <br /> BathtubForced air systems <br /> __ Lavatory(wash basin) Gas piping <br /> Shower __ Water heater <br /> Kitchen sink&disposal Gas fireplace t4 <br /> Dishwasher __ Gas range <br /> _ Clothes washer Clothes dryer <br /> Water heater ///g— <br /> ___ Range hood <br /> / <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> -- <br /> Roof drains _ Other <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority t'violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.jh5t I am au 1 orized by the owner of this property to perform the work for which application is made and I comply with the <br /> State CO actors Law '8.27 RCW and 296.200 WAC. <br /> 6 �� c.)9 <br /> Signature of Owner/Contor/Authoriitr -zed Agent Dat <br /> "7/ <br />