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PE�KMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—wvwv.everettwa.org <br /> �� �lG�- /�j <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT S CREDIT CARDS ARE NOT ACCEPTEU <br /> SITE ADDRESS PARCEL TA%I.D.A PERMIT A <br /> I 31 C �u -t S OOy303a� 00700 CGKc.q-oi <br /> LEGA LOTNO. BLOCK TRACT „ �� <br /> oesc. 1 LR� c1F E�"tRe�T ��U. O <br /> OWNER ADDRESS CITV2IP PHONE <br /> NPAck ac��s, �NsT. 3qaa. $,�^t�r,. tic �ve�l-�- 962�5 �ZS 3a�-1360 <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> �el N�c1�C y2S�Zqo� a4a9 <br /> H N��TOR � 31aa 8�Eg9 �� �v�,CITY2IP PHONE �360 <br /> � (3'RD5. /.�s'�, c FY� N E ���- �2Us 1-�LS .��' <br /> CONTR.UCENSE�I HAAc�B�JJIe�DZ <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5 F ,\ Eleclrlc �Ges Other ��� K <br /> WORK OESCRIPTION , <br /> SFCz /�/ S' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FO(TURE OR ITEM <br /> � Toilet A/C–airhandlingunila <br /> � Balhtub � ForceJ alr systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower L Walerheater <br /> � Kitchen sink 8 disposal � Gae Iireplace <br /> ,� Dishwasher Gas range <br /> L Clothes washar � Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain RefrigeraUon <br /> Grease trap Waodstove <br /> _ Roof drains _ Other� <br /> Olher ` _ <br /> CIiY OF EVERETT LOCAL SALES TAX CODE IS J703 <br /> I hereby ceritity that I have read and ezaminad lhis application and know lhe same to be We end correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifled herein or not.The prantinp ol a pertnft does not presume <br /> to give authorily to violate or cancel the provision of any other state or local law repulaUng constructlon or the perfortnance of <br /> construction. That I am authorized by the ownar of this property to pertortn the work for which applicaUon Is mede and I comply wilh the <br /> ate Contr rs Law 18.27 RCW a 296.200 WAC. <br /> �, � <br /> ignatur wne on thoriz t ate �/L <br />