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( . <br /> � a <br /> � PERMIT APPLICATION <br /> CI�-lf OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> ���Q'� . APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �.� ��`� PARCEL TAX I.D.# ERNJIT# <br /> �.retc� W 3, g 2o d�'4425' Oo 0 240 l �� �r'/ �- 1 Z <br /> LEGAL LOT NO. BLOCK TRACT <br /> oesc. _p� A�R4oi�S S�Ap <br /> OWNER ADDRESS i CITY/ZIP PHONE <br /> �u�,�Sac�c\�,w�er-� �-1�(� lv?.o N�BCr.va'�1�d �yev.d�1��CA £r18• 24tE"f323T <br /> "� �c000 � 9t2o3 � tRo <br /> TENANT NAlME CON�pC T Fp R P Rp�IT PHONE <br /> �Tc"b`.rc.� �v���.�n . ,Je',i+ strc�b;�rc. yoco- tc-r4 cn�l`1' <br /> 01 � �4ssvo. <br /> CONTRACTOR —r' �� !� ,�'w,M� A�ORES CITY2IP PHONE <br /> �.� lre. <br /> CONTR.LICENSE k r : `- � �'� <br /> � ��ta�,� �m� <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���'������' �\� _Electric �Gas_Other �P ��/ � <br /> WORK DESCRIPTION -t"Qnnccv.,�,'\`�C`o�c,�,v„av,,,'�' _ ��n��v��-[1S. �Nn �net`> 7 '�� �v���v�0,• �`'J <br /> ���l1�Y' crr-�•����M.S�-ti• c�s� �.�nn��`(��ir-�(�GS '�1-{-�vA. � i.�� �`.��n,w�0 <br /> � .��`.c<<,. 1J¢....� rINP.L duc�.+er��d:��vsJ'3 ��n\1,�5. l�1-ac.5c 5�c �l.a.��cfds 5'.a� <br /> Work" o�. � vJ�\ .o � Q �.�d�f (�:k � w.' <br /> PL MBING MECHANICAL ' <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ rVC—airhandlingunits . <br /> Bathlub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower 1 L _ Water heater <br /> = Y.ilchen sink 8 disposal �;•r+w,Pq.(�'�{', _ Gas fireplace <br /> _L Dishwasher _ Gas renge <br /> Clot s washer _ Cblhes dryer <br /> Laundr tray Range.hood <br /> � Sink(servi bar/mop/etc.) 1_ Exhaust fan <br /> _ Backflow preve r _ Heat pump \ <br /> Urinal _ Unit healer <br /> _ OrinkingFountain\ Boiler <br /> Floordrain � _ Refngeration <br /> _ Grease trap Woodstove 1 <br /> Roofdrains `� J_ Other �uGTwot� � <br /> � Other �loo�f S�y.Y�i _ ' -kiSor <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> I hereby cerilify thal I have read and examined this applicalion and know the same to be lrue and conect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specifed herein or not.The grenting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any olher stale or local law regulating wnstruction or the performance of <br /> constru 'on. hat I am authori d by lhe owner of lhis property to perform the work for which application is made and I comply with the <br /> Slate tr tors La 1 .27 CW and 296200 WAC. <br /> ignatur o wne ontrac dAuthorized Agenl ' uete � <br /> �� <br />