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PEkMIT APPLICATIOh <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-R857 —www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � G�/ (J ' �� � <br /> SITE ADDRESS �� n � ^ n �1'w�� 0 O P(�ARCEL TApX I.D.ii , . PER IT� <br /> � ls <<o l3 � 1ZS (��Oa i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PNONE <br /> t����`�(j���4/�YGT (Z LLC 2-1� � (��I�l- F�lL,� �.1i- �Il=ak'f�✓h`18Lo1 '�t25 Zl . <br /> TENANT NAME CONTACT FOR PERMIT PHONE L �O <br /> /V1 S`CQ.J,M O�la►ME"�� � I M�js 11� �tl �L��N 2G� ���7� `t� � � <br /> CONTRACTOR� v��,�/Nr�SCV PI�Y`W�HA��SS ��5 ;�y W'MR'�/1' S'r'CITYlZIP PHONE <br /> ��,,�v�� ��p.-7y''+ . �3`Iz <br /> CONTR.LICENSEt! ��6 2�� �,, � 40n, a �ZJ � �6"L72 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> E� nT�M cT � � _ElecUic _Gas_Olher <br /> WORK DESCRIPTION <br /> I���b �t -�^� � P�-�v�c?i�1 b �T 6Z� � <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Oalhlub Forced air syslens <br /> Lavatory(wash basin) Gas piping <br /> Shower � Walerheater <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Golhes dryer <br /> I Water healer Range hood <br /> _� Sink(service/badmop/elc.) _ Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap � Woodstove <br /> Roof drains �2�x� _ Olher <br /> I Other��J�— _ <br /> CITY OF EVERETT i.00AL SALES TAX CODE IS J105 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to be true and correcL All provisions ot taws and <br /> ordinaces goveming Ihis type of work will be complied wilh whether specified herein or not.The granting of a permit does nol presume <br /> lo give authonty to violale or cancel lhe provision of any other slate or local law regulating construction or the peAormance of <br /> construction.That I am authorized by Ihe owner of this property to pedorm lhe work for which apptication is made and I comply�•ith the <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> SignaWre o(Owner/Contractor/Aulhorized Agent Date <br />