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( � <br /> PERMIT APPLICATION <br /> CITY QF EVERETT PERMIT 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 �� _ S—O`� <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT A` <br /> �i�11t1 f��\o_warc AL� c�o�iiozco��C2oo n�Uc� ! � �012 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. ���- oCU 17'CO C-�C�1t�llur� t�{t.15���5 ,a � <br /> OWNER -- - - ADDRESS CITY2IP PHONE �?�> ZS`CS� I`«� <br /> �o.s� 1 (� �r�.c�� ���l u ��e� o..� a i� fl-t;� i�c.�+-t_�!-1 u�A q� z n 3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE 3 Uq � (S�t,� t 13 I <br /> Sa.mc a� 3a�-n--� ��ng <br /> ev=n c tr E-MNL �UI�{GI'1� M � �[Li�h�� � • <br /> CONTRACTOR ��.1�,� �0.}�n � hIL ADDRESS S�C C FQGtRG CITY/ZI PHO E �`(O 'u�� . CUYI <br /> � tn.�,� �=�t„csa�e �i3� <br /> CONTR.LICENSE# a�y�.yzC`FFF�I�`��� �- �•JF� C�Q�2�{� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S�� _Eleclnc �Gas_Other 3 z� y �oo <br /> WORK DESCRIPTION <br /> �' � !. �;��� �,`� �.L1 ��lc� ��— <br /> / D <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> Toilel !VC-air handling units <br /> Bath�ub = Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> 8acktlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby ceritily that I have read and examined Ihis applicalion and know Ihe same to be true and correc�. All provisions of laws and <br /> ordinaces c�overnin �his type of work wil complied with whether specified herein or not.The granting of a permit does not presume <br /> to give thority to Rlate o c nceld e prov ion of any olher state or local law regulating construction or the performance o( <br /> constr ctiqn.Tha an)au o i � y the owner of ihis property to pedorm lhe work for which application is made and I comply with the <br /> State o 'trac(ors aw 1 C nd 296:200 WAC. <br /> ' i i� ��_ � �.-�1�1' <br /> Sig at re o er/Contr ctodAut orized Agent Date <br />