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PE.(MIT APPLICATIO� . <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 <br /> SITE ADDRE33 PARCEL TAX I.D.N PERMIT N � y� <br /> %117 Czon2 S, C�m-�Tr�✓A�`�`u-'1 �' _L/�/.� <br /> LEGA LOT NO. BLOCN iRACT OR SUBDIVISION M <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE <br /> n,���uE coN�E-r z��� ceo� sT cvestcrr 47l 37ti 3`1ll <br /> TENANT NAME I CONTACT FOR PERMIT PHONE �� y u 4q,n <br /> �I�P�IE Corlr-E'/ Si�� �M+StA� E-MAIL`�e"'�'�lM'OS'/�V�^'6� M <br /> �a�rttA 5;�� S�Ns,� N <br /> ric/�cN'�r� �Ar•�s�.ewc, c.L� r7SoS 2-nn hv� NE r�+n+t�5��u� NzC ytz 4c6o <br /> CONTR.LICENSE M <br /> �"5� SotieNt-L`1/3NE <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> fbM� .�C Eleciric Gas Other $ I��,,� ,ip <br /> WORK DESCRIPTION <br /> 1NSTy.�.��r.iy PiMC-K-Fi.oW P!t¢�Cn"t�L CIM1n-�(s4Ci0�.7, <br /> PLUMBiNG MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FI%TURE OR�TEM <br /> Toilet A/C-air hendling unita <br /> Bathtub Forced air systema <br /> Lavatory(wash besin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen elnk 8 disposal _ Ges fireplece <br /> Dishwasher Gesrenge <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (servicelbar/mop/etc.) _ Exheust fan <br /> �� Beckllow preventer _ Heet pump <br /> Urinal Unit healer <br /> Drinking Fountain Boller <br /> Floor drain Refrigeratlon <br /> Grease trep Woodstove <br /> Root dreins Other <br /> Other <br /> CITY OF EVERETT LOCAL 8ALE8 TA%CODE 19 7706 <br /> I hereby ceAity Ihat I have read end examined Ihis application and know the same lo be true end correct. All prov(slons of lawe and <br /> ordinances governing this type ol work wili be complied with whether specified h�rrein or not. The granting ot e permit does nol preaume <br /> to give authority to vidate or cancel Ihe provision ot any olher state or local law reguleling construction or the peAormance ol <br /> construction. That I em eulhorized by the owner of this property lo perform the woik for which epplicalion is made end I comply wlth Ihe <br /> State Contractors�aw 18 2 RCW a 298.200 WAC. <br /> �� � �� `'�5��°— <br /> Signature of Owner ontraclor/Ayt rized AgeT a� <br />