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� <br /> P�RMIT APPLICATIC�N <br /> CITY OF 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 2 �!3—�� <br /> SITE ADDRESS PARCEL TAX I.D.# RIJAyT# <br /> 2�1 ��- �1� � �-? � �v� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHON4���4aZo <br /> (�c �c�� S CoP—F� lZl�1- 113��� t�',� 5� � 03 � Rt�c.n� �n�R 9�0 _ <br /> TENANT NAM E CONTACT FQR PERMIT PHONEA n� �7>�ZCa <br /> ...�4 <br /> �G �O(VPcI.D`S �-�FW� '��l/`9� E-MAILWI�MCG.�'Ar'�'h`mk� e� <br /> ONTRACT R ADDRE CITY2IP P ONE <br /> l�lU�-4P�NlS M�b4�`1�c.�L �to3 �t'ct�l A� �'C" `t4�cl 'FZ53a3�$ <br /> CONTR.LICENSE#�l��l O,p,� �^ /� � v�� <br /> U'p p"[ <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher �2��j � <br /> WORK DESCRIPTION <br /> t 1.�5�- `�� R- S r ��S �R- N� C=�� �InSC� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FU(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling unils <br /> Bathtub Forced air systems <br /> Lavalory (wash basin) _ Gas piping <br /> Sho�ver W ater healer <br /> Kilchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gasrango <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range ho <br /> '� Sink(service/badmop/etc.) _ Eahaus an <br /> Backflow prevenler _ Heat ump <br /> Urinal U ' heater <br /> Orinking Founlain _ oiler <br /> Floor drain Refric�eralion <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> _ Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify lhal I have read and examined lhis application and know lhe same to be lrue and correct. F+II provisions of la�vs and <br /> ordinaces c�oveminc�this type of work�vill be complied with�vhelher specified herein or not.The c�ranting of a permit does nol presume <br /> to c�ive aulhority to violale or cancel the provision of any olher state or local law regulating construction or lhe performance of <br /> Iconslrucf ial I am aulhorized by the owner of lhis property to periorm lhe work(or which applicalion is made and I comply with the <br /> � Sl onir r aw 1 .27 R and 296.200 WAC. <br /> ' -`�//z,/�08 <br /> ature wn C traclor/AuUiorized genl �� Date <br />