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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� .-� �-/� <br /> SITE ADDRESS SB �� �(��o b.DW A`( PARCEL TAX I.D.It PERMIT A� <br /> E�ERCTr� WA Q6Za3 280 SO SOOZo33a � C1�1u -p�l( <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. (p C.J !fi(2�t"�� 5� 1Z02 — Ei' 8S <br /> OWNER ADURESS CITYIZIP PHJNE <br /> BETHI w�TME2 5� 8 31- 6R op,DwPY �` �r Qr'� 5g zo 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> g R NY= SAN� 4 2S -S13 -4:38 0 <br /> E-MA�L <br /> Z`T> . <br /> CONTR.LICENSE N CJ����� <br /> USE OF BUILDING �i� � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S F R ol `" V-� �L�1 cs-+ �� � _Electnc �Gas__Olher <br /> �.n,fw+�^ <br /> WORK DESCRIPTION <br /> G �,lc �es� 3o Sa.Fr� o � Go �F �ra �r_ CK Fo,". �p� uaRY� VP6(tA�L� <br /> wl� nawS� ccu � KRT GAQA6ETu 6FbRooM� R �EMaD �� PA �z oF <br /> r1 �ltsuFb 'gHS � N��J'i FOR �1 �'rGHF a <br /> PLUMBING MECHANICAL <br />. NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet __ ��� '3 ,a '� A/C—air handling units <br /> Bathfub Porced air systems <br /> _ Lavatory(wash basin) �:1,�� 'I�>� _ Gas piping <br /> Shower Water heater <br /> �_ Kitchen sink &disposal _ Gas freplace <br /> Dishwasher Gas renge <br /> Z Clothes washer � Clolhes dryer <br /> Water heater J_ Range hood <br /> Sink(service/barlmop/elc.) _f_ Exhaust fen <br /> Backtiow preventer Heat pump <br /> Urinal Unit heater <br /> �rinking Fountain Ooiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstpve <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby certify that I have read and examined this application and know ihe same to be true and correct. AII provisions of laws and <br /> ordinances governing this rype of work will be complied with whether specified herein or not. The granting of a pertnit dces not�'esume <br /> lo give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance ot <br /> construction. That I am authorized by the owner ot ihis property to perform Ihe work for which application is made and I comply with ihe <br /> S a Contradors !aw 1q.27 RCW d 296200 WAC. <br /> •�7�. <br /> ��^�-� 1 -� �d �: i,� o <br /> Signature 3f OwnedContractor thonzed Agent Date �/ <br /> •-) r-, k � : r � c..{ �cr . ,.�1-I,,•��`,�>.� � •��ti-�- � I <br /> 1 "� <br />