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� P��tMIT APPLICATIOr�� <br /> I CITY OF EVERETT PERMIT SERVICES <br /> ; 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—w�n�w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS '�"" LAZA PARCEL TAX I.D.# �RMIT# <br /> 62�- �adw �#v - U <br /> LEGA LOi40. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> �'�� 3�0 /��'it��-s 2�17 /'W��.e�'.� �f�C°- f,,,a.¢�l- <br /> I TENANT�-fDi1i/�j� �'� € ���G I CONTACT FOR PtRMIT PNONE <br /> � �..-.� GJ�Z <br /> � G -z3`F- <br /> 'A /5 ���ov� Li.•ri �'°a,.��t�s7p <br /> CONTRACTOR fJ1�y�,,,, c,�,� -y_,L ADDRESS CITY2IP PHOHE <br /> CONTR.LICENS/� I�`/C > �J� <br /> �`'�v `� ,u�"`�`-�v �- Zs-� ��6-z3�-� Z <br /> G�vtt,s;96 r;J z <br /> USE OF BUIL�ING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas Other ��D� <br /> WORK DESCRIPTION <br /> I ,tu��� �S� �,1�.� S�-� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE UF FIXTURE OR ITEM <br /> _ Toilel A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Waterheater <br /> _ Kiichen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clcti�es washer Clothes dryer I <br /> _ Laundry trey Range hood <br /> Sink (servicelbadmop/etc.) Exhaust fan <br /> _ BackOow preventer Heat pump <br /> I = Urinal = Unit heater I <br /> Orinking Fountain Boiler ' <br /> _ Floor drain Refrigeration � <br /> _ Grease trap Woodstove <br /> Roo(drains Other � <br /> Olher — <br /> I — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> iI hereby cerilify that I have rnad and examined this appliealion and know the same to be true antl correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> I to g�ve authonty to violate or cancel the provision of any other state or local law regulatinq constrvc6on or the performance of <br /> consiruc hat am authorized by the owner of this property to perform the work(or which applicalion is made and I comply with the <br /> Stat� ontra Law 8.2? RCW ar�d 296.200 N�AC. <br /> �� �y- �2 - Z '> - �y <br /> Si natur of Owner/C�lrr ractor/Authonzea Agent Date -� � <br /> i 'IL I <br /> i <br />