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PE, :MIT APPLICATIO�: <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERElT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> -n <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NO'f'ACCEPTEQ <br /> SIT ADDRESS ����1� PARCEL TAX I.D.# P RMIT# <br /> �d��J�Er/�f��cJ� u�� ��zr�S � vy/vz. a�vo�/c7 d� - � <br /> LEGAL LOTNO. BLOCK TRAG7 <br /> DESC. <br /> �WNER ADDRESS CIlY21P PHONE <br /> / A-J�Ac'/fic. i='f r�i` �A2o�' Z Co2 3 `� iu y:.y�/VE_ SL rLf,v i ..cIA �'jdo 3c:� z s 3 as� s o� <br /> TENANTNAME CONTAC1TFORPERMIT PHONE <br /> hJA�27 Nlifi 5 n/f�,Pec.ir'f.c� �ON �YC�F�� �J�o �v"i'O —.37��g <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> S �C�E� ,^�Fti��.•.��c�a L 8�lys �-iti�1' Sr Ss ��oa W�Ar�J✓IcL� <br /> 1/ �����a yas- yo�-i�3o <br /> CONTR.LICENSE# S,4C���C M�'L��'�'l�I� <br /> USE OF BUILDING I HEAT SOURCE I�ONTRACT PRICE OF WORK <br /> 14,I <br /> �LJ����� _Electric _Gas_Other I � . ��� <br /> WORK DESCRIPTION ' <br /> Adb 3 �-�«�� Sr�1�s, � /�nlfl5rn1�5 fF�1� 1'- P�EP S�n1,�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIIRE OR ITEM <br /> Toilet A/C—air handling units <br /> Oathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> � Sink (service/barlmop/etc.) _ Exhaust fan <br /> Backflow prevenler Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratlon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have raad and examined this application and knuw the same to be true and correct. All provisions of laws and <br /> Iordinac�governir�g lhis rype of work will be complied with whether specified herein or not.The grantina of a permit does not presume <br /> to givaauthonty wo�te or cancel lhe provision of any other state or local law regulating conswction or the performance of <br /> � con tfuction.T ti horized by the owner of this property to perform the work for which application is made and I comply with the <br /> i Sla , ntrac s L v�2�R6W'and 296.200 WAC. <br /> � ��- G- _ � l �� � 0 3 D <br /> i S g��ture o( wne Contr or/Authorized Agent Date I <br /> l% <br />