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. � f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-$810—FAX 425-257-8857—www.everettwa.org <br /> IAPPLICATIONS ARE AC:CEPTED FROM 6 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AI'JRESS � PARCEL TNX I.D.# PERMIT M <br /> 3631 t3t2oadc.� s,^ XU � �I_ pp <br /> LEQAL LOTNO. BLOCK TRACi � <br /> DESC. <br /> � <br /> OWNER ADDRESS CITYIZIp PHONE <br /> G�w��,�.r 36o Nok�l� 27r L�oc I-4zS-�ia••�z/0 <br /> � ��P�le�./�u� C��rv�l,W `�f32[�� <br /> TENANT NAME � �s� C ACT FOR PERMIT PHONE <br /> Qv�z�os STc�fZE I C(;� �' �.,� <br /> (- 5�-�lzZ-j�Ooa <br /> CONTRACTOR pDDRESS CITYrIP PHONE <br /> C!k►T� ��.b,��< <►�o� F ��,����y �.�a � ��- <br /> CONTR.LICENSE X <br /> UN1.T' �z, .5�, GT' I- 5����1-Z-��o <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Lp)1�}�,1e���Q ��({` ` _E�eqric _Gas_Other ���? �s— <br /> V <br /> WORK DESCRIPTION <br /> I `E�I�AWT �-Lv�v�p���Ll,(C'.w`�� �cG� � Z <br /> 1 � - � <br /> �LUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR ITEM N0. TypE OF FIXTURE OR ITEM <br /> Z Toilet VI _ A/C-airhandlin unils <br /> � Bavatory(wash basin) ���� �O Pe� — Forced airsystems <br /> Gas piping <br /> _ Shower � Water heater <br /> Kitchen sink 8 dispasal Gas fireplace <br /> I Dishwasher � _ Gas range <br /> _ Clothes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> (p� Sink(service/badmop/etc.) I II Exhaust fan <br /> _Z Backflow preventer �� Heat pump � <br /> _ Urinal _ Unit heater <br /> DrinY.ing Fountain Boiler <br /> ? Floordrain i� Refrigeration <br /> _ Grease trap �{-2� Woodstove <br /> Roofdrains _ Other <br /> � Other F�xc 5;,4s tll <br /> , 17 X In°� - 17n�i-25�- ��',5� — <br /> CITY OF EVERETT LOCAL SALES 7A%CODE 13 3706 <br /> I hereby ceritify Ihat I have read and examined this anpliration and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this lype ot work will be conplied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authonty to violate or cancel the provisio�of any other stale or local law regulating construclion or the perfortnance of <br /> construction.That I am aulhorized by the owner of this property to perfortn the work for which application is made and I comply with the <br /> Slate Contradors Law 18 7 RCW and 296200 WAC. <br /> � <br /> �� //-/� <br /> Signature wner/Coitra or uthonzedAgent Date <br />