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i <br /> I�CRMIT 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ( `3 I�� <br /> SITE ADDRESS PARCEL TAX I.D.N i'ERMIT A <br /> ��'D1 �P�a.�r Op5 Zo0 4dU /� (o I� -� <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> er✓N (2o6evf�5 �$o'[ C�edm�r �'Ue� ���oi ¢zs z99 s�z�6 <br /> TENANT AME CONTACTFOR�ERMIT PHONE <br /> I �•�/4P�lc M— C�lu— 4-ZS SU I �3(0� <br /> CONTRACTOR RESS��„� s Z /.._C4TX21P �/��MQN€7 � ' �! <br /> MC r'F W �•�' tjl <br /> ���sT�8Gl511C7 �i-wNe�c� ll�� 9�Z9� <br /> USE OF BUILDIN6 I HEAT SOURCE CONTRACT P�tICE OF WORK <br /> / Oa <br /> �ay�C /��e _Eloctric _Gas_ Other 28 �, � <br /> 6 n <br /> WORK DESCRIP ON � �x �f. � / / fJ_ , '�G � e <br /> c r6Ho,1• (Y���•Y <br /> .�� � � � � w�n eW 3r��30 x 0 <br /> PLUMBING MECHANICAL , <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM � <br /> Toilol A/C-alr handling units <br /> Bathtub Forced alr systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchon sink 8 disposal Gas fireplace <br /> Dishwashor _ Gasrango <br /> Clothes washer _ Clothes dryer <br /> Waler hoaler _ Range hood <br /> Sink(sorvicelbarlmoplotcJ ` _ Exhaust(an <br /> _ Backllow prevenler � ' '7 ��- / , __ Heat pump <br /> Urinal / � � � _ Unit heater <br /> _ Drinking Fountain , , , _ ` � �j Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> O�hor <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I horeby cerilify that I have read and examined this application and know the same lo be true and correct. All provisions ollaws and <br /> ordinaces govorning ihis type of work will be complied with whelher specified herein or nol.The granling ot a permil does nol presume <br /> lo givo aulhority to violale or cancel tho provision of any olher slate or local law iegulaling construction or lhe performance of <br /> construction.That I am authorized by the owner ol this propeAy to periorm lhe work for which applicalion is made and I comply with Ihe <br /> Slale C nlrar.lors Law 18.27 RCW a d 296.200 WAC. p <br /> � ���!� 6���a� <br /> Signalure o wnodConlractodAu�horiz d gent ale '/ <br /> � Z <br />