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� P�tRMIT APPLICATI(�N <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 ADDRESS '�F H S- 2 i� I PARCEL TAX I.D.N PERMIT# <br /> 3003 W �� S��1JRcI ��'J_ Z 53�4 � UCL7100ZOD I XUS �>S U'v'� _ <br /> LEGA� LOT N0. BLOCK iRACT OR SUBDIVISION 0 <br /> DESC.J <br /> OWNER ADORE55 CITVIZIP PMONE <br /> �o�; �—_—--- ��11c UA4 <br /> TENANT� CONTACT FOR PERMIT PH���4b� 2.E�iZ S <br /> ��'�_ `U ___ �(� S—_J__U�"lAv1SON E-MAIL <br /> -�b —_�AbDR€�3`- ,--_Z`TFViZT� <br /> 11'1W_DoV�c.l�+l M��lel —!�� '1 �'t�u�+ �� yst+lle 9.41Zy 2ub <br /> CONTR. LICENSE N 7b-3-9400 <br /> (y�{� c:. fl o F� �,a V 12�l _ --- <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK _ <br /> L/�`�Electrir. Gns Other <br /> --._---�---� -- —.. _--- -. <br /> WORK DESCRIPTION 1�\� j���� M���R,�„ �i.� C �(.t"„6"ny <br /> ---- - - _ _--- -------- MECHANICAL — � <br /> PLUMBING <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl __ NC–air handliny units <br /> �- – �.�������� _ forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Showr,r _ Watm hoator <br /> Kitchun sink 8 dis�wsal _ Gas liroplace <br /> Dishwashc�r _ Gas range <br /> ClaUir.s washcr _ Clothos dryer <br /> � Walcr he.+tor Rango hoad <br /> 1 Sin4.(scrvicePoar/moplotc.) 1 Exhaust fan <br /> ....— f3ackllow prevenler �_ HFa�pump <br /> 3 Urinal __ Unil hcater <br /> _j_ Drinkin� Powitain _ Boder <br /> Floor diain _ Relrigorelion <br /> � Grcasc irap _ Woodslove <br /> Roo�drains ��"� _ O�hcr <br /> 5 Other�i✓��� ��_ — <br /> -- � �tr�L�{��ye- iJ�`Je✓ — — <br /> CITY OF EVER[TT LOCAL SALES TA%CODE IS 9705 <br /> I herr,by cerilify lhal I have reaA and eaamined�his applicalion anA know ihe same to be irue and correcl All provisions o�laws and <br /> ordinacr.s go��orninq ihis lype ol work will bo compllod with whuther spacifled horein or nol. Tho granting ol a Vermit does nol presume <br /> � 1„grvo authunly lo violale ur canrel Ihe provision ul eny nihur slato or loc.il law regulaling conslrudion or iho pr,rtormancu ol <br /> i unslru�.lion. 7hnt I am authorlaeA I�y the owner ul Ihi�; property lo ��orform tho work lor r�hich applir,alion is made and I cumply wilh the <br /> Sl:de Contrar.�ors Law 1827 RCW anA 296.200 WAC. <br /> ' S�i o/o S <br /> � `,iqnn ur,of OwnedC��odAulhonzed Agent Datu <br /> � _. __--- —.__ ._ ... <br />