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i <br /> � <br /> PERMIT APP!ICATIO�I <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 7 ,_, i5�TI�' <br /> SITE ADDRESS PARCEL TAX I.U.# PERM��rir <br /> 5�1� =ver t-e.o.n 1�?A.� �3 3 co2 ���'�O �rC�7-5 <br /> LEGA LOT NO. B`L CK TRACT OR SUBDIVISION N <br /> DESC. <br /> 04YNER AODRESS CITY2IN PHO („'�fj J�y,� <br /> C��YiS�' LR,k"1��rti�'-he.S 5`!v3 C�re�'-q�e��1 �Cu.� G�e� R8?�3 <br /> �TE�NANT/�NAME , -1 CONTACTFORPERMI PNON (,42� �$ 3� �� <br /> �1LGC��i C.(��� Ml.�/��F��IU .S �1r1 � G�-ea,n E-MAIL�hYI `J�NL�Me. �N\ <br /> CONT ACTOFi • ADDRESS CITY/ZIP PNONE <br /> Ac�a�'s ��.µ�-n� (3tp�>c��t 2�s3 <br /> CONTR.LICENSE# <br /> USE OF BUILDING (�- HEAT SOURCE I CONTRACT PRICE OF WORK <br /> `��,ti� �./�p-��1,-�lu u.Y I n� _Eleciric ]` Gas_Olher <br /> WORK CESCRIPTION <br /> �E-�1ac.e �o:.�,n �a�r I�,n� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUflE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> Kitchen sink&disposal _ Gas lireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelbadmop/elc.) _ Exhaust fan <br /> Backflow preven�er _ Hea�pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease�rap _ Woodstove <br /> Roo(dra!ns Olher <br /> Other — <br /> GTY OF EVEREIT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces governing�his rype ol work will be complied wilh whether specitied hernin or noL The granling of a permit does not presume <br /> to gfve authoriry to violate or cancel the provision of any olher state or local law reguialing constmction or the pedormance ot <br /> construction.That I am authorized by the owner of this property lo perlorm the work for which application is made and I co�:ply wilh the <br /> Stale Contr aw 1827 RCW and 296.200 WAC. <br /> �Z���t� _-----�'�E� 7 I <br /> �a re ni Owner/C ilfactor/AuthonzeTAgenl Date <br />