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PE�tMIT APPLICATIO� a <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �p5 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �G ''�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> ?�o '� Gt�?-G�,-r M�.�t,� / z���� � o z� �'�ll� =� <br /> � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 5���� C�C�-e�-�T" L� Z�kl15W �R�t-�5� n�wPot� ��=�e�.��o <br /> �ENANT NAME CONTACT FOR PERMIT PHONE <br /> 1��� �h W��.� �S �Z� �03 o'SZ8 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> W�u:.t FM1S MCebtPd��cRZ (Ne. 3�03-�^"��� P�►� � �'���� �fLS �3 d� <br /> CONTft.LICENSE# / ' `t���O���� — <br /> lN <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> �nn,�� Nc� �.. 4�,�ZI�s ��r�Q- �n� p� ,�.�— <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> r1.. Toilet A!C—ai andling units <br /> Bathtub Forced air stems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> � Kilchen sink f:disposal _ Gas freplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dry <br /> Laundry lray _ Range ho <br /> � Sink(=ervice/bar/mop/etc.) _ Exhaus an <br /> �, — Backllow preven!er = Heat mp <br /> Urinal Unit eater <br /> Drinking Founlain D 'er <br /> I � Floor drain —51N(� _ frigeralion <br /> Grease trap oodstove <br /> I Roof drains ���.r Othec <br /> � Olher y-�a ��v�-- — <br /> CITY OF EVERETT LOCAL SALES TA`!CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhoriry to violate or cancel lhe provision of any olher slale or local law regulating consWclion or the per(ormance of <br /> construclion.Thal I am authorized by the owner of this property lo peiorm the work for which application is made and I comply with the <br /> Sta ���w .27 �N and 296.200 WAC. <br /> � Z5 �� <br /> �S' alure of wner ontrac ut n ed Agent ate <br />