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/ <br /> P�r2MiT AP�LIC/4��I���J <br /> GTY OF EVERETT PEt.�?�:"� �ERVIC�� `�=a-g�-�� <br /> 3200 ,:EDAR STREFT, Eb'ERETT, WA 98201 <br /> 425-257-Sf�10— FAX 425-257-8857—vnvw.everetriva.o;g !�,-•�, ��, ��t (_ <br /> �__�:.. . <br /> APPLICpT�ONS ARE ACCEPTED FR�7M 8 AM TO 4 PM - 9EBIT ti CREDIT CA'r',DS AR� Ii0' �+�::;:i7;,:;: <br /> SITE ADDRESS ppRCEL TAX I.D.# ���tdAIT# �f <br /> 5 `�OS �"U�Q R�eG� ulq� 393 -ooa - alz � oo. S '� �� <br /> LEGA: LOTNU. BLOCK TRACT <br /> DESC. <br /> OWNER '� ADORESS CITY2IP PHONE <br /> %�9[, �i�il9ui!e - �iiLi�/022 ��'�1 �Sf9�e �705 r've'aq2ee.� �!/AY Ep�Rn/{ �/.13 3S6�36j' <br /> TENANT NAME CONTACT FOR PEItl411T PHONE <br /> (�-�!'x S��ef��eer 3Ea 79v <9Giy <br /> CONTRACTOR ,��pG�o NfoN � ADDRESS CiTY21P PHONE <br /> �1 /&'0 ��9�z6 ou a P.l�re,f��c �og /yl�,�n110 915 3�iq So9y <br /> CONTR.LICENSE# rq�ol�Jt/�oyyop ��y� 5//y/oG <br /> USE OF BUILDING I — HEAT SOURCE I CON7RACT PRICE OF WORK <br /> G�t<�-,('�a[-,Fst-slc- Sa/e,� <br /> !��/�•t rc�• Electric Gas Other ��5� Q� <br /> WORK DESCRIPTION <br /> l � .��,�, ���� - .�x� � - <br /> � � ��� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITE�d NO. TYPE OF FIXTURE OR ITEM <br /> __ Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> _ Backfiow preven;er Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain �oiler <br /> Floor drain Re(rigeralion <br /> _ Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX COOE IS J105 <br /> I hereby ceritify that I have read and examined this applicalion and know lhe same to be lrue and con�ct. All provisions of laws and <br /> ordinaces governing this lype of viork will be complied with whelher specified herein or nol.The granLng of a permit does not pres�me <br /> to give authority to violate or cancel the provision of any other state or�ocal law regulating wnstruction or the pertomiance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applicacion is made and I compiy with the <br /> State Contry Glors Law 1 27 RCW and 296.200 WAC. <br /> y; •. <br /> 6('i�� �_ ��,.�G� ��y-aS <br /> Signat re of Owne�r/ ontraclor/Aulhonzed Agenl Dale f/Z <br />