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P��tMIT 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 E AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT q <br /> �0�, �o€n s a o�oe3-000- o tb - oo ��9� � <br /> LEG.1L LOT NO. BLOCK TRACT <br /> DESC. b Y�� 2�c4� A�n r�oN p�v 3 <br /> OWNER ADDRESS CITY2IP PHONE <br /> �osH l�osT�WK t531 `I Z$H (�rS�. I�liu, Cr�e,X �8Ula y�s '1`1S6?39 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 7ono��r Kosr��Y I� (ti�s)��s- 6�39 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# y <br /> -���i� P_JUL/ � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I �'�M �� _Electric �Gas_Other <br /> WORK DESCRIPTION /', <br /> ���7r1.� �'}�a� � �"" �� �a�� <br /> /" ✓ <br /> dv�cu�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> � Toilet _ A/C-air handting units <br /> � Bathlub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> �_ Shower � Water heater i <br /> _ Kitchen sink&disposal Gas fireplace f <br /> Dishwasher Gas r.nge � <br /> _ Clothes washer , �iothes dryer �� <br /> _ Water heater � �' Range hood <br /> Sink(service/badmop/etc.) � ,s� Exhausifan - <br /> Backflow preventer Heat pump � <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> F!oor drain Refrigeration <br /> Grtase trap . Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3705 <br /> . I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws am� <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority to viol e or canc the provision of any other state or local law teg�tlating construction or the perfoi mance of <br /> constructi . t a a thoriz by the owner of this property to perform the work for which application is made and I comply with the <br /> State C nd 296.200 WAC. <br /> Z� � <br /> ign w ., ct orized Agent D te � <br /> � Z <br />