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P�RMIT APPLICATIG�+I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 93201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS P.RE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS AFE NOT ACCEPTED <br /> SITE A�DRESS PARCEL TAX I.�. # P,'-,'R1:1IT# <br /> 2�D� Co� qV� ouy3916zs6aloo >�I � � - a�' I <br /> LEGA I.OT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYI2IP PHONE <br /> sK o�cr� M�r1a�K ccc P.e. �oY r269 �✓�Fr� <br /> TENANT NAME CONTACT FOR PERMIT pHONE <br /> �'Ey g�+✓K I Sf�✓� �t3�/LUn/ (206� 2tz_�Toa <br /> CONTRACTOR �fa,����,�.� S�b�/ COR�I ADORE�S CITY2IP PHONE <br /> 12SS wFSrcq�CE ql'6. i✓• �qa6/ ?d 2—G7a0 <br /> CONTR.LICENSE# �1�1(OSC �31M3 S�R��(� �4i� QQIOq <br /> USE OF BUILDING HE4T SOURCE CO�TJ�ACT PRICE OF WORK <br /> ��}/✓k /O���C� _Electric _Gas_Other I —Yf /�JQB � <br /> i� <br /> WORK DESCRIPTION <br /> /Nf7M1�L '7t�o S�NltF F?C� /(.tNn'�Ir�M(Cp V,}�I,L SIl�✓f (/1�0/� !!X/l7l�✓� <br /> PLUM8ING MECHANICAL <br /> NO. 7YPE OF FiXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toiiet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Y.itchen sink&disposal Gas fireplace <br /> Oishwast • Gas range <br /> _ Clothes wasner Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflow proventer Heat pump <br /> Urinai Unit healer <br /> Dnnking Fountain Boiler <br /> _ Floor drain Rc-frigeration <br /> Grease lrap Woodstove <br /> _ Roof drains Other <br /> I _ Other — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> II hereby ceritify that I ave re and ekamined ihis application and know lhe same to he true and wrrect All provisions of laws and <br /> ortlinaces govemin is typ work will be complied with whether specified herein cr not.The granling of a permit does not presume <br /> to give authority to i late or ncei the provision of any olher state or local law regulatiny consWction or the pe�iormance of <br /> construction.That I m aut r zed by the owner of this property to per(orm the work for which application is made and I comply wilh tha <br /> State Contractors L v 9.2 CW and 296.200 WAC. <br /> ��-�-�y <br /> Signature oi Owner C ntract Authonzed Agent Date i�� <br />