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F�E�cMIT AQPLICATIOIv <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 /> pu� �1�-� <br /> APPLICATIONS ARE ACCEPTED FRQM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> I IS Gh�sk��n�- 5�� o0 3�,3��600 �o�o Co a -o <br /> LEGA LOT N0. BLOCK TRACT �� <br /> oEs�. n �6 �R-r vF cvE�er� D�v o <br /> OWNER ADORESS CI IP PHONE <br /> 4-��1Ac`c 6�os, Cs��sT. 3`�aa 8�'A�.0 , �1E E�e�c� 9�2� �I2S�.3��1-�360 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��el Ncaack tizs-a�n-a�29 <br /> CONTRAC OR ADDRES CITY2�P PHONE <br /> N+�wc�c QP..cys� c��lr�-c. 39� S��'q�e,NE �125= 3�1�-73�0 <br /> CONTR.LICENSER �Ue�.4-� y�OS <br /> Nr�Ack ti-=n�a D z <br /> USE OF BU�LD�NG I — HEA7 SOURCE I CONTRACT PRICE OF WORK <br /> 5�� Electrlc �Ges Olher 1 �U V� <br /> WORK DESCRIPTION <br /> N l:W S'F � /o� S <br /> PLUMBING MECHANICAL <br />� NO. TYPE OF Fl%TURE OR ITEM NO. 1YPE OF FI%TURE OR ITEM <br /> � Toilet AIC—alr handling units <br /> � Bathtub Forced eir syatems <br /> Lavatory(wash basin) Gae piping <br /> Shower Water heater <br /> = Kitchen sink 8 dispo�al Gae fireplace <br /> J_ Dlahwasher Gas ranpe <br /> � Clolhes washer Clothes dryer <br /> _ Laundry tray Ranpe hood <br /> _ Sink(service/bar/mop/etc.) � Exheust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Bailer <br /> _ Floordrain Refrigeratlon � <br /> _ �rease trap Woodstove <br /> _ Roof drans � Other <br /> Other <br /> IGTY OF EVERETT LOCAL SALES 7AX CODE 19 710b <br /> I hereby ceritily lhat I have read and examined this appllcatlon and know the seme to be true and cortect. All provislona of lawa and <br /> ordinaces goveming this rype of work will be complied with whether specified hereln or not.The prantlng of a permit daea not preaume <br /> to give authority to violate or cancel the provision ot any other state or local law regulatlng consWctlon or Ihe perfortnence of <br /> constructlon.That I am aulhorized by the owner of this property to perform tha work for which appllcaUon ia made and I comply wilh the <br /> S e Contre Law 18.27 RC and 296. 0 WAC. <br /> ignaN o wner ntractonAu on d Age ate �1 <br />