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1 <br /> PEFtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 . <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org /� <br /> I� �� �o� 'a� <br /> PPPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT 8(:REDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT N / <br /> I �\5 C.C(�s'�o P-�D �d3`136C�b�101��GZ � o "7� O/5 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. (�U Ec.CQv`(Y � M�.=� � CTS <br /> OWNER ADORE93 CITY2IP PH E — <br /> NA�„c B�� ���s-r. 3`�d3� �1�°PNE.Nc ��eET� 9tiioS N1�S-3q�-'13�0 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �oel Naack ►�2s-a90 -a�a9 <br /> CONTRACTOR ADDRES9 CITY2IP PHONE <br /> H�+d� (3pa�• cn�s�, 39a,�. $�+��.NE �e�e-t-r 9�c� <br /> CON�CZ N 'l(.�" ,J`11'^I3G7O <br /> 6Z 1 � � <br /> USE OF BUILDING AT SOURCE CONTRACT PRICE OF WORK <br /> � F � _Elecl�ic �Gas_Other /� 9 /3 J <br /> WORK DESCRIPTION <br /> N� Sf�� j�� ! � /OD <br /> PLU.. .�NG MECHANICAL <br /> NO. TYPE OF FU(TURE UR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—alr handling units <br /> � Balhtub 1 forced alr aystema <br /> Lavatory(wesh basin) � Gas plping <br /> Shower � Waterheater <br /> � Kitchen slnk 8 disposai � Gas flreplace <br /> � Dishwasher Gas ranga <br /> ,j_ Clothes washer 1 Clothes dryer <br /> _ Laundry tray T Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretlon <br /> Grease trap Woodslove <br /> Rool drains Other <br /> Other <br /> I — — <br /> � <br /> � CIiY OF EVERETT LOCAL 9ALE3 TA7C CODE 19 7105 <br /> iI hereby ceritify that I have read and examined this application and know the same fo be true and carrect. All provislans ol laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not The granNng of a permit does not presume <br /> to give authority to violate or cancel the provision of any olher state or local law reguletlng conatructlon ar the periortnance of <br /> Iconstruction. That I am authorized by the owner of this property to perform the work for whlch applica0on is made and I comply with'ho <br /> Slate Contiact Law 18.27 RCW and 296.200 WAC. <br /> Sig ature o wnenContractor/ �zed Age t � Z) at� � <br /> �v �d2� <br />