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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� a— � <br /> SITE ADDRE55 PARCEL TAX I.D.# PERMIT N <br /> 'z733 Co� a�r Rv� Q lD� 0� � -�t <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> ALL�N I�cw�►MQr Z625� CoLoy Prti(3 3-Zz6 Ev��a.r.-rr 981,01 <br /> TENANTNAME I CONTACTFORPERMIT PHONE �y0 3QQ 'L'70S <br /> Z��(Ltk1Lt.. /•+��la m , kt 1�•,Ott.l4�/ E-MAIL n��kN9�dN4+S�'AtAM <br /> L�pT'ff7C I I <br /> (�Y1,eN0 �liew $�y� 3 AwN��b Co�++pw+� S3"�3 Gu.oc Na�a,a�,� F3 360 3q8 2705 <br /> CONTR.UCENSE p gE LL�N(au QN+ WA Q B Z2(r <br /> GR,eNt�v59S3�'2 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRiCE OF WORK <br /> QET�+�- Eleclric Gas Other � �, �3�• �b <br /> WORK DESCRIPT�ON <br /> '� NS��-1 NO�I -L�-�.�1N'�� N4TL:f� CuT LE�"R.5 Fo2 S�4w�(�� ow W�ST <br /> � $pvT'►+ LLV"vA•r7 on.J S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> OalMub Forced air systems <br /> Lava�ory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kifchen sink&disposal _ Gas fireplace <br /> Dishwashcr Gasrange <br /> Clo�hes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backllow prevenler _ lieat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Fioor drain Refric�eration <br /> � Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 7105 <br /> I hereby ceriity that I have read and examined this appiication end know Ihe same to be�rue and correct. All provisions of laws and <br /> ordinances goveming this type of work will ba complied with whefher specified herein or not.The granting of a permit does nol presume <br /> to give authority to violate or cancei Ihe provision oI any other stale or local�aw regulating construction or the peAormance o( <br /> construction. That I am authorized by lhe owner of this property lo pertorm the work for which application is made and I comply with the <br /> Sfate Conlractors Law S .27 RCW and 296200 WAC. <br /> _� <br /> Signature of r/Co itractor/Au iorized Agenl Date � I� <br />