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P��RMIT APPLICATION <br /> CITY OF EVERETT PERNlIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> _ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � /�–�=�-- - <br /> — ��--- <br /> SITE ADDRESS PARCEL TAX I.D.# MIT# <br /> -J��Xx E� C�IQr�GG S{� Ct �0,58/��� �� o � 0 � a� - ool <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � Z ,So✓ND Vltw Aani Io,tJ �� E�skETT, ✓OL i P O <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> T,w� a.,cl k,�'e a � Ila Ysoo ffA�bov� P{ Bl�a( �l635 M�k�fCO w�I `��S'�S`��ZYZT <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I T� S�cllu `1zs- 7s `1 - 28�3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# ' <br /> UJ�t�:.�_, <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Si�y(� F'q.���� ��¢S,�i..�c< _Eleclric �Gas_O�her <br /> WORK DESCRIPTION <br /> Csnsjr✓c� /t(,�.eJ pfl $:��.c �wt• �y �C 5'`tl��ct . <br /> J <br /> PLUMBING MECHANICAL <br /> NO. 1'fPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toiielr�� A/C—airhandlingunits <br /> � eathlub 111 � Forced air systems <br /> �_ Lavalory(wash basin)I C� I Gas piping <br /> 1 Shower �_ Water heater <br /> t Kitchen!ink 8 disposal 1_ Gas fireplace <br /> �_ Dishwasher .� Gas range <br /> 1 Clolhes washer �_ Clolhes dryer <br /> �_ Water healer Range hood <br /> Sink(service/bar/mop/etc.) �� Exhausl(an/ <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiier <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE�5 3105 <br /> I hereby cerilify thal i have read and examined Ihis application and know lhe same lo be truo and cortect. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.Tho granling of a permit does not presume <br /> to give aulhority lo violale or cancel ihe provision of any other slate or local iaw regulaling consWclion or the performance o( <br /> construction.Thal I am authorized by the owner of lhis property lo perform the work for which applicalion is made and I comply wilh the <br /> Slate Contraclors Law 18.27 RCVJ and 296.200 WAC. <br /> �,��/f� Di-oz- o� <br /> SignaWre o(Own onlractoUAulhonzed Agent Date <br /> 1/ <br /> W 3,�� <br />