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Prf�MIT APPLICATIUN <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 /> 'J APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � ' �� Y` UG <br /> SITE ADDRESS /' PARCEL TAX I.D.R PERMIT t �� <br /> ' �� — ( �3i� D � I �3��`�lo O�I o <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE 1�2�_�z_5� � <br /> � & Q �NVES'I MENTS Z���� � « � S'f • A1E Tucpu(� qgi�i 425-�-72-IS I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> gALB�R S iNGH L1tS —232— �SS / <br /> CONTRACTOR ADDRESS C�TYIZIP PHONE <br /> CONTR.UCENSE p ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> —1_ _[lociric _Gas_Olher <br /> WORK DESCRIPTION <br /> ��� � �� � � , ��- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilot A/C-�air handling unils <br /> Balhtub Forced air syslems <br /> _ Lavatory(H�ash basin) _ Gas piping <br /> Shower . Walorhoatcr <br /> Kitchen sink 8 dis�xisal _ Gas lir�place <br /> Dishwasher Gasrango <br /> Clothos washer Ciolhas Aryer <br /> Walon c�ater Range hood <br /> Sink(sarvica/badmoplcic.) _ Exhausl fan <br /> Backllow preventer _ Heal pump <br /> Urinal . Unit hcator <br /> Drinking Foun�ain _ Boller <br /> Floor drain _ Retrfgorelion <br /> Greaso trap _ Woodslova <br /> Roof drains Olhar _ <br /> Olh�r ---.- — - <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I horeby ceritity Ihal I have read and examined this application and know tho samo lo be tme and correct. AI�provisions ol laws and <br /> ordinaces povorninp ihis typo of work will b��+complied wilh wholhur spocifiod hereln or nol.The granting of e permit does nol presume <br /> to givo aulhorily lo violat�or canccl the pro�'sion ol any olher state or local law regulating construclion or the performance of <br /> construction. Thaf I am authorized by tho owner of Ihls proparty to perfurm lhe work(or which application Is made and I comply wilh lho <br /> Slato Conlractors Law 18.27 RCW and 296.200 WAC. <br /> `�Ig�a , ►b/�3 /os <br /> Signaturo ol Owner/Contractor/ uthonzed Agenl e�o <br />