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, <br /> PERMIT APpLICATION ��� �``�� <br /> CITY OF EVERETT PERiNIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 r�'�� <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PEAMIT# <br /> 3�t61 Low.�f� Qv� (�y 3s �soo t oa --.� <br /> LEGAL LOT NO. BLOCK TR-AyCT O-R1 SU IVIS�ION#�y� <br /> OESC. � �.y�. Z �L�� T I�'f �v`U�'1 l �`� � <br /> OWNER ADDRESS CITY2IP PHONE <br /> �l ;�.. P S-�u+;� �+� ��1sfi ��5-Z� a���Z2 s�-4z��,� <br /> �TENANT NAME CONTACT FOR PERMIT PHONE <br /> I -Da� �V�',��er 2�-235-1017 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> QWV�(.✓� <br /> CONTR.LICENSE p <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> c " � <br /> J`��\ _Electric _ Gas __ Olher �S�D OD <br /> WORK DESCRIPTION <br /> -[�s�.� �a.�,�el �1�.� ��, 7-o l�` <br /> PLUMBING MECHANICAL <br /> NO. TYPC OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl _ . NC-air handling units <br /> - �- Forced air syslems <br /> � Bathtub -- <br /> � Lavalory(wash basin) _ _ Gas piping <br /> Shower ___ Wa1cr heater <br /> � Kitchen sink R disposal _ Gas lireplace <br /> Dishwashcr _ Gas range <br /> Clothes washer __ __ Clothes dryer <br /> W2ter heater _ Range hood <br /> Sink(scrvicc/barlmop%e�c.) � Exhaust lan <br /> l3ackflow preventer Heat pump <br /> Urinal Unit hcater <br /> Drinking Fountain Doiler <br /> Floor drain _ Hefrigera�ion <br /> Grcase Vap __ _ Woodstove <br /> Fooldrains __ Otlier_______ . ___ __. <br /> O�her _ . . .. . _._ .. -----� - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examincd Ihis application and kncw ihe same to be irue and coi�ecL All provisions of laws and <br /> ordinaces yoveming ihis type of work will bo complied with whether specified herein or not.The granting oi a permit does no�presume <br /> to give authority lo violale or cancel ihe provision of any olher state or local law regulaliny construclion or the performance of <br /> conslruction.That I am aulhorized by 4ie owner of lhis property to perform Ihe work lor which application is made and I comply with the <br /> Slate Co iraclors Law 18.?7 RCW and 296.200 WAC. <br /> L�c Mw-��Z� S s <br /> . Sig at re ol OwnedCoNraclodAuthorized Agent Date / <br /> '! � <br />