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�'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810—FAX 425-257-H95�--www.e��erettwa.org <br /> APPLiCATI0N5 ARE ACCEPTED FROM 8 AM TO 4 PM -DEBiT 8 CREDIT CARDS ARE NOY ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> Il�{oo E���� w.d.� �vcYy29ooyo/So3 , <br /> �EGAL LOTNO. BLOCK TRACT <br /> DESC. F��V ar <br /> OWNER ADDRESS CITY2IP PHONE <br /> (/-�4L Mysd-'r S<-eR�S',T.�. yoo ( 5� Io�ST. �'T°^1`Q1'cc��7�/�a �`f���(-2rb� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> (�.�NI��T To'rtD .���Y C6a3) 90'7-00�0 <br /> CONTRACTOR(��= 1,,�21 µ� �Vp� ESS E ��W� 'S'�'t-fA P�O�TH�.d.�.l',l� O��IZL3U <br /> CONTR.LICENSEV CC�,T/��.�-����y CS"o3�4o� -oe'7o <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ��L'` Eledric Ges Other �SSr aoo <br /> WORK DESCRIPTION <br /> (�'111U ,,�C'.��r( �1�4L� <br /> PLUMBING MECHANICAL <br /> N0. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air liandling units <br /> _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shovrer Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> __ Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> —� Sink(service/bar/mop/etc.) Exhaust(an <br /> _ 8ack0ow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkin9 Fountein Boiler <br /> Floor drain Retrigeration <br /> Grease trap Woodstove <br /> Raof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL S'�LES SAl(CODE IS]106 <br /> I hereby ceritify that I have read and examined this appliwtion and know the same to be true and corred. All provisions ot laws and <br /> ordinaces goveming this type of work wiil be complied with whether spedfied herein or not.The grenting ot a permfl does not presume <br /> to give authority to violate or cancel the provision of any other state o�local law regutating construdion or the peAortnance of <br /> construction.That I am authorized 6y the owner oi this propeAy to peKorm the work 1or which applicetion is made and I comply with the <br /> State C Law _ RC nd 200 WAC. <br /> 2/�/Qs- <br /> Sign neq ont ctor u o zed Agent ate <br /> V, 1 <br /> � <br />