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PERMIT ApPLICATION <br /> Cli'Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S1 REET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.orp <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I P �j1T � - � <br /> � g-o ¢ a��rw vF o0 3 � o o�/On ��� <br /> LEGA LOT NO. BLOCR TRACT OR SUBDIVISION N <br /> DESC. � � gEy�,2� y �[g,ppS �l✓ l BLK Oi03 D-o 0 <br /> OWNER ADDRE&S CITYIZIP PHONE � ` <br /> 7 <br /> SA��S �l��l-�-C�-1�t-Al /4 0 4- BA�-� � t �f k� � , , �fi a�� 6 ri� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> Ol✓f�r—�atsr�ss— <br /> CONTR.LICENSE M <br /> USE OF BUILDING — HE'AT SOURCE � CONTRACT PRICE OF WORK <br /> S�n y/e 'nl./K(�4 Electdc _Gas_Other I �+ S� ��� 1��.�i� <br /> ..� <br /> WORK DESGRIPTION <br /> N�w �Cec,�C (�a x � � ) <br /> PLUMBING —�— MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air nandling unils <br /> Bathlub Forced air systeme <br /> Lavotory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink B dis�osal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clolhes wa�her Clothes dryer <br /> Waler heeter Range hood <br /> Sink(servico/barlmopletc.) _ Exheust fan <br /> Dackllow preventer _ Heet pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeration <br /> Grease Irap _ Woodstova <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL 9AlES 1A%CODE 19 J105 <br /> I hereby certify that I have read and examined this npplication and know Ihe same lo be Irue and correcf. All provisions o(lawe end <br /> ordinances goveming this lype of work will be complied with whelher specified herein or not. The granting ol a permil doea not presume <br /> Ilo grve authorily to violale or cancel the provision ol any other slate or local law regulating construction or the performance o1 <br /> construction. Thal I am authorized by Ihe owner ol lhie property to perlorm the work for which application ia made and 1 comply with the <br /> Sta e CoNractors w iB.27 RC and 298200 WAC. <br /> � � =� � �.. 9 • � . � o � <br /> 5ig ature o Own ctor/Aulhorized Agent Dale <br /> �Z <br />