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) <br /> PL,��MIT APPLICATIG.J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS PARC L TAX I.D.#, P MIT# <br /> �S O 1--,-�L�2(��� LJ' 003 .�3zoo3o�5�d �o " '� <br /> LEGA LOTNO. BLOCK T ACT op 3 3Zoa3� � aaG <br /> oesc. oU7 37Ud �p � iov <br /> OWNER ��I��� LSp(�'L�j�I�S ADDRESS CITY2IP PHONE <br /> F�L` F3n1Sr�2- � �'t �a-vv�eS � �0 (52� 296U i�✓e✓e � �o�l <br /> TENANT NAME CONTACT FOR PERMIT PHONE �Z�b) 6S-U-3303 <br /> �YLie►� �\ 1�.� �cS�I�SId�lC�Cti�r f1�"�����✓YI �42ti) �71^09Z6X ;z37 <br /> CONTRACTOR ADURESS CITYIZIP PF?7NE <br /> �N�sc� c�-�s�c�,� ��� �� 6 Soo3 � ���.r�o� (yZ>>���-�9z� <br /> CONTR.LICENSE# <br /> �nl�sc� c� 07� �� �i�,�o�s c,�- ��'ayG <br /> USE OF BUILDING �^ HEAT SOURCE CONTRACT PRICE OF WORK <br /> � W �c�C� � f — — ���� ��6 <br /> U, � ��f�� /2 Electric .r�Gas OthPr <br /> WORKD�CRI TIO lS�a� J��`n � (j�o�'k�� ��CuytvOl �CICh� �v IZe (�i'-� � 171�C+�h <br /> ��' Z'in-�� 1 / hQ �Ir�'�� � �UC�' C'Ch7 �'V�2�"e �C.K�L �.t <br /> � g��,,�� �,c� S,}� h�� P�e P' w� <br /> Ne�e�e c� s rs sd�a+-� �-- ��s �-� i5C�F1� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel .NC—air handling units <br /> Bathtub ' Forced air systems <br /> Lavatory(wash basin) _L Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> _ Laundry tray Range hood <br />- - Sink(service/badmop/etc.) � Exhaust 1an <br /> Backflow preventer Heal pump <br /> Urinal Unil heater <br /> Drinkinc� Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove . <br /> Roof drains � Other �R��t'P�c.c'�-h ' <br /> Other �_ P(Lcp S iY+r�c h <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same lo be Uue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The grenting of a permit does not presume <br /> to give uthorily to violale or cancel the provision of any olher state or local law regulating construclion or the performance of <br /> constru ion.Thal I am aufhorized by Ihe owner of this property to perform the work for which applicalion is made and I comply wilh the <br /> Stale Uaclor ^ w�t8�7 RCW and 296.200 WAC. <br /> G-z -o.� � <br /> ig t ed ntra _liorized Agent Date � <br />