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P�RMIT APPLICATIUN <br /> CITY OF EVERETT �'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT ti � <br /> �S'� �.�e r�e t�,a.c. ' ;'l�1 ��,� � .�7 <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNE_'R/' ADORESS C�TY21P PHONE T� ��K.t <br /> �r77i� CP.aSe�'S��llGQ�''cy��/' $53D f,c,� ��en w�yfic�e� ,?l� 9G/ a'�.�3 <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> L�?�{� C�se/'S I ,0 1e��� ��O �G�- / 7 <br /> CONTRACTOR iL� QQQ/;�t/q�10✓1 ADDRESS Q/ �� CI�IP PHONE �� <br /> 2-a� �PB� G� U 8�`�l79 <br /> CONTR.UCENSE# �tGI�S�<(D�Y"�� i�" l•.-. ��'�-.�: I'�ON.�'/'dp� �t6a'Z <br /> 7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT FRIC�OF WORK <br /> ���� �� //J m�� _Electric �' Gas_Olher / 5"'Dv �(/ ��' <br /> K—C <br /> WORK DESCRIPTION <br /> ��-1-6`�' .Q✓c�t�o �1 ��Prw � 5-�s� �r/� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OP FIXTURE OR IIEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas ireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clolhes dryer <br /> ^ Laundry tray _ Range hood <br /> Sink(servicc/badmopletc.) _ Exhaust fan <br /> Backflow preventer Heat pwnp <br /> Urinal Unit heater <br /> Drinking Fountain oiler <br /> I _ Floordrain Refrigeration <br /> I = Grease trap = Woodstove <br /> Roof drains Olher <br /> Olher <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I havo read and examined this application and know the same lo be true and corcect. All provisions of laws and <br /> ordinoces goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violale or cancel the provision of any otlier state or local law regulating conslrucUon or the periormance of <br /> construction.That I am aulhorized by lhe owner of Ihis property to perform the work for which application is made and I wmply with the <br /> State ra tors L . 7 RCW and 296.200 WAC. <br /> .i �/ D%=0/ O.� <br /> Signature ot OwnerlConlractodAut Date <br /> � <br />