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� <br /> P�RMIT APPLICATIZiN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �l��D�3 <br /> 425-257-8810— FAX 425-257-9857—www.everettwa.org <br /> �4�� -� <br /> APPLICATIONS ARE ACCEPTED FROht n pM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT A CEPTED <br /> SITE ADORESS PARCEL TAX I.D.N PERMIT A� <br /> �3 aq Cl�c,s`�►�� - OG 43g3 �a�6- aK -o�! c.�+�o-orc� <br /> LEGAL LOTNO. BLOCK TRACrtT � .{�- n <br /> DESC. � � `/�D CuL'�C�J ,�f �I.S1��1„D4 1.�� �! ��. 9 <br /> OWNER ADDRESS CITY2IP PHO E 3�,.�) � <br /> Kenr►e')��h1a►cnec C�riS�� $ao� �'�b p�, NE• �la� stiilk `�17D ws-a�r u <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR rm � ��Y� ADDRESS CITY2IP PMONE <br /> CONTR.LICENSE N ,) ��N��,r,��p/� ` O IR�A� Qd�'^" d"^"�\ <br /> K U p t/CT <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PftICE OF WORK <br /> S� (� =Flectdc !Gas_Other <br /> �� <br /> WORK OESCRIPTION <br /> ���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F;�CTJRE ON ITEM NJ. TYPE OF FIXTURE OR ITEM <br /> —� Toilet A/C-airhandlingunita <br /> � 6athtub � Forcedairayslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wator heater <br /> T Kttchen sink 8 disposal = Gas flreplece <br /> T Dishwasher � Gas range <br /> = Ciolhea washer � Clothes dryer <br /> Laundry tray Range hood <br /> Sink (servicelbarlmop/etc.) �, Exheuat fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain _ Boller <br /> Floor drein RefriBerellon <br /> Grease trao Woodstove <br /> _ Roofdrains � Other MICYCWAVe <br /> Olher <br /> ICITY OF EVERETT LOCAL SALE9 TAX CODE IS 7106 <br /> II hereby ceritify that I have read and examined lhis applicatlon and know the same to be true end correct. All pmvlslonn of lawa and <br /> ordinaces governing this rype of work will be complied with whether specified herein or nat.The granling af a permit does nol presume <br /> I to give authonty to violate or cancol the provision of any other state or local law regulatlng construcUon or the peAormance of <br /> � constructlon. That I am authorized by the owner of this property to perform the work for which applicatlon Is made and I comply with the <br /> i State Conva�ors Law 1827 and 86200 WAC. <br /> � . � r�,ao� �01�3 �t�} Y <br /> � Signature o wner! ontractor/ uthonzed gent a <br /> I <br />