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i <br /> PERMIT APPLICATION <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 K O7(G -�)f �j <br /> SITE ADDRESS � PARCEL T/lX I.D.# PERMIT p <br /> 3c�3 0.�. s�tico �p, a54- ZBo�-ISoo� oo� oc� p�sTs��traL'�— <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> (3 oc�Nl� u.� . P. o . P�ox �n5 I F �9 5E}ti'�'fLE wA . <br /> TENANTNAME CONTACTFORPERMIT PHONE 25'3 a'7j'�y—IZq'�L <br /> i����� Lt-�'S4 ('`� D I J Ps,MC� 4�vAl2� ��'ME Mai� F�r� sYsro�swEs cw, <br /> F�szE sY��ns wEs-r, wc. 2i`i FfioN�rp.4�. Fzo. rt.�� <br /> CONTR.�ICENSE p P�C I F I C� tnlA �t�0 '� <br /> FI R-�swi �4oe� �2-s3� 833-i z 4-�a <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �,O yVl/� , Elec�ric _Gas_Olher � 5/�O� � <br /> w <br /> WORK DESCRIPTION �Q CAT£ ��.r,F�,E�-h,� `� ��M I Q�r01 (3UI�...D/��/L� <br /> 1 (�-�Vlpc NEW f� '� 5Y(LihIK�E�-S C2$� � • <br /> ��-�s� �'� Pi PC <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OH ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ ___ Toilet _, A/C—air handling unils ' <br /> _ __ _ Bathlub _ Forced air systems � <br /> ,. Lavatory iwash basin) ___ Gas piping <br /> ___ Shower Water heater <br /> _ Ki�chen sink 8 disposal _ Gas lireplace � ,{ <br /> _ __ Dishwashei Gas range �,� � <br /> __ Clo�hes washer _ Clolhes dryer � � ��` `� <br /> ___ Water heater Range hood �1 ,�n�• �� <br /> ____ Sink(service�barlmoU'etc.) � Exhausl fan �. 1 <br /> ___ Backllow preventer Heat pump ` �� �V` �`�� <br /> _ _ Winal Unithea�ei �Z�� �"' ;;'� ` <br /> __ Drinkmq Fountain Boiler , � d <br /> . _._ Floor drain Retrigeiation ` �'�S��`A' <br /> ._ __ Giease Irap Woodslove <br /> _ Rool drains O�her � <br /> -- Olher --- —�— <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hmeby ceril8y thal I have read and examined Ihis application and know Ihe same to be tme and correcl. All provisions ol laws and <br /> ordinaces goveming this type ot work will be complied with whelher specified herein or noL The granling ol a permit does not presume <br /> lo give aWhorily lo violate or cancel the provision of any other state or local law regulaling conslruction or Ihe perlr,rmance of <br /> conslruclion. Thal I a ulhor� ed b e owner ol Ihis property to perlorm Ihe work for which application is made and I comply with the <br /> � Slate Gantraclors CW d 296200 WAC. <br /> ' L b zs o <br /> SignaWre ol O edC IractodAuthorized Agenl Da� � / <br /> �� <br />