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PERMIT APPLICATION <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 /> 1G f J /C/I�I�llil�7 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �d -/y-D 2� <br /> SITE ADDRESS _� PARCEL TAX I.D.# PER�IIT Jf <br /> IZ�I �VERETT �VE o0434 �N�B�r000 .CZ',�"��/"�1` <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE <br /> MC.oP�o 12�31 I13�`�" -hY� NE Su�T� 103 Ki�K�trtO.wa 900� 4z5.8zi•44+ro <br /> TENANTNAME CONTACTFORPEflMiT PHONEL�25.02�.2�00 <br /> /v�C.DON��p�S I,�OSN WILI.IAMS �IN�f 1 NS E•MAIL JWIu-IHMSQ F}lpARCH.(4 <br /> I <br /> TgD <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> CoMMER,�A� FIdT F�D RE5�7WR�Nlf —EleGric _Gas_Other � 'j� �O <br /> WORK DESCRIPTION t.IEW gEvE-Rh•� g�yZ � <br /> N24o�FhT�t34�9Eco(L NEW RD�.F , � <br /> •-NE�—'P��t� New 7R�sN Coi=2A� H�t�--S�r.tr�1f��a'K� <br /> NEW C8ILINC� NEW Rh�K Da7R ���+�`��aF �� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. NPE OF FI%TURE OR ITEM <br /> Toilcl A/C—air hendling uni�s <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shovrer Water heater <br /> Kitchen sink&disposai _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washcr _ Clothes dryer <br /> Waten c�ater Aange hood <br /> ' Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit heatcr <br /> Drinking Foun�ain _ Boiler <br /> 1 Floordrain Retrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same to be irue and wrrect. All provisions ot laws and <br /> ordinaces goveming this rype of work will be co��plied with whethcr specilied herein or not The granting of a permit does not presume <br /> to give authorily to violate or cancel ihe provision of any other state or local law regulating constmction or the pedormance of <br /> conslrur,lion.That I am aulhorized by the owner of this property to perform the work for which application is made and I comply wiih the <br /> S) te Contre or w 1827 RCW and 296200 WAC. <br /> F¢��41Ett.� Ho �RCHilt�PS <br /> . ZS .O <br /> nature of OwnedContracto Authorized Agent Datc / <br /> , l <br /> / Z <br />