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PEr�MJIT APPLICATIOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 CEDA.r2 STREF_T, EVERETT, WA 98201 <br /> 425-257-8810-� FAX 425-257-8857 —www.everettwa.org � �_ �c� `��8 <br /> APPLICATIONS ARE ACCEPTED FROfi" 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS /aR�= NOT ACCEPTED <br /> SITE ADDRESS �3 PARCEL TAX I.D.# PERMIT# <br /> � o1O S6 GV�rc;f� Ma-(� i(l Z��t .57� DD> DI/o ;'^ �/�CC',� <br /> LEGAL LOTNO. BLOCK RACT <br /> DESC. 4,c�� S�('F.�T`rj <br /> OWNER ADDRESS CITYiZiP PHONE <br /> �'iri'�r.(- Co�� Iolb � �vcrc�!-M.�(, w�ay �IbZ �tW/� yzs coy •a4YL <br /> TENANT NAME CONTACT FOR PERMIT PhIOPJE <br /> �1 eVo�'��c-. ��1����'.i�oP✓���� '� Cot�Vtl,l,��cyf�u �z.S G(D •loZB6 ��a l� <br /> CONTRACTOR '�.� ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT FRICE OF WORK <br /> D��G�';� �E�eclric _Gas_Other �,j Z�OU�O <br /> WOf.KDESCRIPTION �� � �r�_ 5� �D�j� ViLW" Fu12Ll�I" U/�c-US NCVJ' IOMs'-.LG.QXCa.� <br /> I��%U)' c�LVlM.S� � <br /> L <br /> _Si4lk- • %° , L�24-�^�l.S -�'D fLl.��ltq c{,vLc� . �•J'^^'"�'"n-n-`i�' e.w�'� c�6dV' <br /> J � <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM17 <br /> . Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> �_ Kilchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clolhes washer C�olhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaus:fan <br /> Backflow preventer Heat pump <br /> il _ Urinal _ Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> ! Roof drains Other <br /> i Otha,r <br /> I — — <br /> i - <br /> '. CITY OF EVERETT LOCAL SALES SAX CO�E IS 3105 <br /> ' I hereby ceritify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> �' ��. ordinaces govem�ng this type of work will be complied with whether specified herein or noL The granting of a permit does nol presume <br /> ito give aulhority to violate or cancel the provision of any other siate or local law regulating cons:ruction or the performance of <br /> construction.That I am authorized by the owner of this property to perfnrm the work(or which application is made and I comply v:ith lhe <br /> iState Conlraclors Law 16.27 RCW and 296.200 WAC. <br /> Signatwa ef OwnedConlractoUAulhorized Agent Date <br /> ��Z <br /> i <br />