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P�RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERV�i.ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810-FAX 425-257•8857-vwvw.everettwa.org �3� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 rM -R���- -Q(I <br /> SITE ADDRESS PARCEL TAX I.D.A� PERMIT x <br /> '-f8�I1 Gle.��o�� �e . ��a�e'H 982U3 u2`10�{3(0 -003- OZO-OG �9 <br /> LEGA LOT NO. ��"� BLOrCK TRACT OR SUBDIVISION R <br /> DESC. �,�.� �pS�. 7ys�t•kkG� <br /> OWNER ADDRESS CITY2IP PNONE <br /> {7� �-e,r �op0�1 N841 61a�+woo� /�vE.,��erp'l-� `/�103 <br /> TENANTNAME I CONT CTFOR ERMIT PHONEc�ZS-(�'A7�SIOS <br /> Ro�, �,�,� <br /> 3TLfZE.,�.;.,e�ria�,��c. e-Mu�Fo.,e7'K��r.co� <br /> Z`'6ATRAL VSB Cs�..4FrH���a.� SS�9 /le.�^d 5�. S�.J Ed�.o,.�s -�Sa:lo 91i- 3'1.3-7ys.Z <br /> eoN�+.uceNse M;r5i3cp�,�E q S$R 7 <br /> �E OF BUILDING I , //A HEAT SOURCE I CONTHACT PRICE OF WORK <br /> /�[ <br /> e�c.in ����� QajN�w� '�a dr,ve Electric _Gas_Olher �7 Q�� � <br /> WORKDESCRIPTION"�,,,.,o�e �Pr�a,:,.,�}ely qOLF o� Q��s��nc "Ul+�ubfock" w� I.�� G��'•� uP <br /> � 61�biliLc �}(,� .SIoP� colu2re SOt l.F 6� w•�!( -�..'/.c� �,{/eb.,: /� Ul,L r6/v�,� c�•��/ <br /> W��� Ol'��r•C� � c/r'v.�a c,p 'JC�r C�.tJliH.P�'i od d�S.9 n . /'1�SJ 6in c.G TOQ .if !li�OaiT <br /> ! <br /> �r�.// Cui�,e.,�/y a�f,'J ns' tt �tf<.h:'..� wa //, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub 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 /> Water hea�er Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backllow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily 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 compiied with whether specilied herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the periormance of <br /> construction.lnat I am aulhorized by tho owner of ihis property to pertorm Ihe work lor which application is made and I comply with ihe <br /> �Slate onlSactors Law 18.2 GW and 2 6.200 WAC. <br /> r�� ,���� 7/3�za.��" <br /> �gnature of�Ow er/Con raclor/Authorized Agent �ate � <br /> �I�, � <br />