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� <br /> . <br /> PERMIT APPLICATION <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 6 ._. ��Q � <br /> SITE ADDRESS PARCEL TAX I.D.7f PERAd�T# <br /> 5828 t.�NruoaD �11� GLS ' <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> S1�1M-IoMI�I- 'Pi,lp 1802 "15� 5T SW �V�R�["f 96203 4Z5�8�3- 569 <br /> TENANTNAME CONTACTFORPERMIT PHONE �-44�..�f�.� <br /> AY T Mo�IUTY I SUNNY YIM e.Ma�S IM SWA•C.�M <br /> -t8D ��2MlT lSs �Z/Z7 n9 <br /> CONTR.LICENSE# /I J�/ �� � I � C �[i 1� �--�� � <br /> � �/ l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> WI� ��`� ��ric _Gas_Other �� D� <br /> WORKDESCRIPTION � T �'RD TD OVI�Y N w� �C`�' <br /> bN R"(�1�15�1 Ng SN a Q IAU �1.� M !t"N � � �C <br /> �CNI�NNA�S a No �PI�ITIt�NPL �-�nt(��N�hl4cl �, CD�—�CD�D �i�1G�HT�1 . <br /> P l �bp <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kilchen sink 8 disposal _ Gas fireplace I � <br /> Dishwasher n� Gasrange <br /> = Clo�heswasher �1y� _ Clolhesdryer � <br /> Waler heater � Range hood <br /> Sink(service/bar/mop/etc.) Exhaust lan <br /> Backflow preventer Heat pemp <br /> Urinal Unit heater <br /> Drinking Fountain BoCer <br /> Floor drain P.elrigeration <br /> Grease irap Woodstove <br /> Rool drains O�her <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know ihe same to be true and correct. All provisions of laws and <br /> ardinaces governing�his type of work will be complied wilh whether specilied herein or not.The granting of a permit does not presume <br /> lo give authority to violale or cancel the provision of any other state or Iocal law regulating construction or the pertormance ol <br /> conslruc' .That I am authorized by the owner of this property to perform the work lor which application is made and I comply with the <br /> Slate C nir ctors Law 18.27 and 296.200 WAC. <br /> 5 �D <br /> Signa�ure O en ont a IOU ut onzed Agent Date �/ <br /> � <br />