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P��2MIT APPLICATICS��1 <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT R CREDIT CARDS ARE NOT ACCEPTEa <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.N P RM�ITJ-,�',r� 1,�� <br /> ZoS EAsr cAS�o R.a ��3- �S '7qv831aZ3a I �� Y""/`�" <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> NER ADDR C TY <br /> �Ooo Ca VItD W�1 <br /> laGwl� '1(�ZKMJ1 Ildq26 WoOD -Qrp f20.Wa �-'ZOS 425-3°16^�iE3 <br /> TENANTNAME CONTACTFOR PERMIT FHONE <br /> ¢�-pQr�E KQ'�'r7+ I�t�MSTREG'r 2ole- 930-'114� <br /> CONTRACTOR z4 S31 g SE 4S��.u�ty �25AC�1VA�} M(/�fl y Bo29 <br /> H E LCc� tn1Ts12 1��SSdb :L1.►C. <br /> CONTR.UCEN9EN H�-COEL Oa$/J�- V - <br /> 2c(,- qb `1140 <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PfUCE OF WORK <br /> L^�NpRor�A�r. I ,�,ei�mc _cae_aner I�O�o00.`� <br /> WORK DESCRIPTION <br /> $�7rII_D O177" O F L I10tJ IJ�f2D M'/tT, <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIIfTURE OR ITEM <br /> l Toilet A/C-alr hendlinp unitn <br /> Bathtub Forced eir eyatema <br /> � LavaWry(wash basin) � Ges piping <br /> Shower Water haeter <br /> Kitchen eink 8 disposal Gas flreplace <br /> Dlehwaeher Gae ranpe <br /> � Clothes washer j,d. Clothea dryer �—D !� <br /> Laundry Vay Ranyflhood__ 3 � <br /> � Sink(aervice/badmap/elc.) ` �xhauel fan� I I <br /> BackBow preventer ' a pump <br /> Urinal Unit heeter <br /> Drinking Fountain Boller <br /> = Floor draln RehigereUon <br /> _ Grease trap Woodstove �� �� <br /> Roofdrains � OtherM111tE VQi41�, _r{�, <br /> i Other _ <br /> i — — <br /> I CITY OF EVERETT LOCAL 9ALE8 7Al(CODE I��705 <br /> I <br /> II hereby ceritlry that I have read and examined this applicatlon and know the same to be true end correct. All provielona ot iaws and <br /> ordinacas goveming this rype of work will be complled with whether specmed herein or noL The qranting of a permit doea not preeume <br /> to give authonty ta violate or cancel the provision of any other state or local law repulaGnp consWctlon or the perfortnance of <br /> construction. That I em authorized by the owner of this property to peAorm the work for which applicadon ia mede end I comply with Ihe <br /> State Contracrora Law 1B.27 RCW and 296.200 WAC. <br /> z�.1v.9- .� oA- z�-04 <br /> I ignature o wner� ontracton uthonzed gent ate <br /> ��L <br />