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i I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 5 ��j.-dg <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org SO��j�"j --0� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT X <br /> ZB1�1 Ce lo Oo�l- `bbl 00 �C�j'o1� <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONM <br /> DESC. � � <br /> OWNER ' ADURESS CITY/ZIP PMONE <br /> �'� �m C��urcl� z�i4 c���h� �✓c. wW 9��l01 �zs-�i-�s3� <br /> TENANTNAME ( CONTACTFORPERMIT PHONE /}Z>. '77(�$$''�S <br /> ��{'l�(�/1 'rVGCiL sk�l2S e•Ma� neW�Ym�1SQbc�'rYnc�n yu. <br /> '�bATtiSL'• tu* <br /> 3erry Ncai s�o�n sysGcros �c�� ;�.rdcsor� t� EYcrcF� w�- 41S-7i1�-5�s35 <br /> CONTR.LICENSE p (!�Y�;7� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> CCVY�Me�'Cic�� Electric Gas_ Other ���}�C Q c� <br /> WORKDESCRIPTION tn�a11 �1> -4v,ro���;�ec�. � ;+ `�,v�cct,n� wal� s���� w�ti� p�ei��lus ���-� <br /> ru��ea cop�� O.�u,ri:v�am {ti�crs . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> NR Toilet � A/C-air handling units <br /> Balhlub Forced air syslems <br /> Lavalory(wash basin� __ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal __ Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar,'mopletc.) _ _ Ezhaust lan <br /> Backtlow preoentcr _ _ Heat pump <br /> Unnal Unit heatcr <br /> Drinking Fountain _ 8oiler <br /> Floor drain Re(rigeration <br /> Grease Vap Woodstove <br /> fio�f drains Other <br /> — - Other —-- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ccriti(y that I havo read and examined this application and know Ihe same to be true and corred. All provisions o�laws and <br /> ordinaces goveming Ihis rype ol work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhorily to violate or cancel the provision ol any other state or local law regulating construction or Ihe pertormance of <br /> conslruclion.Tha1 I am authorized by the owner ol this property lo pedorm the work tor which application is made and I comply with the <br /> a � tprs Law 78.27 RCW and 296200 WAC. , <br /> ' '' ` Zj � . <br /> ���/ / �' <br /> �ghaWre of euContraclorlAuthorized Agen� Date <br /> '/Z <br />