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PL�ZMIT APPI_ICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE�RMIT p <br /> `�$0S Gl�nu�o«� �I ve n,c.c..e. � D�-�' <br /> LEGA lOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> ��y � r`�r Mux ���� 4lehwo-�t Avenue Evere+f; 9sza3 y�s� 3s� <br /> TENANT NAME CO ACT FOR PERMIT PHONE <br /> Sca,� �S �{u'nau 'J o:.L rYl a x 40�5 3y3- a 7y/ <br /> CONTRACTOR Nvr �(nGW� ADDRESS CITY2IP PHONE <br /> y�F <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OP WORK <br /> y`��l �e-17�� I �lectric �Gas_Other 97��7� � <br /> WORK DESCRIpTION . � ,-y� �. <br /> I"-�n.i sh� n� 13c�5er�en4 �h-+e� 1 iv�nc� ��.._ <br /> PLUMBING MECHANICA! <br /> NO. . - ��_LYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE JR ITEM <br /> /�=r Toilet �"� �` AIC-air handling units <br /> ( Bathtub � � Forced air systems <br /> i Lavatory (wash basin)'�!�/�`-. / Gas piping <br /> . Shower � � Waterheater <br /> __.K��chen sink 8 disposal ' � _ Gas firepiace <br /> Di�lvasher-- Gas range <br /> / � Clothes washer � Clothes dryer <br /> Laundry tray Range hood <br /> _ Sink(service/bar/mopletc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> � Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodsrove <br /> � Roof drains Other <br /> Olher <br /> i CITY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> � ordinaces governing this type of work will be complied wi�h whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating conshuction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> -��1 rn� n Dy_ <br /> Signatur f nerlConlractor/Authonzed Agent Date �/ <br /> � <br />