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PERMIT APPLICATION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET. EVERETf. WA 98201 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-25]�BB ID — FAX 425d5Y865� — www.everellwa a9 <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.org <br />/Pp4Cgl10N5 ARE ACCEPTED FROM BAM TO <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIZE ADDRESS <br />SITE ADDRESS <br />� <br />PARCEL TAX <br />PARCEL TAX I.D. # <br />PERMIT # <br />PERMIT <br />342� �1avi- <br />��IZI lf� <br />0093 /,98z3aloo <br />vo4 9gZ3o 0o <br />Qdcoi <br />BoBof <br />IEGA� LOT <br />iew wn <br />ewcrc <br />BLOCK <br />TRACT OR sueomsroxe <br />TRAC70R SUBDIVISION# <br />DESC. <br />1� P� MOgE58 2V <br />OWNER ADDRESS CITY/ZIP PH' ENE <br />98z58E(zs�876� <br />�ti � <br />xax,xue <br />TENANT NAME <br />ox.nn.on.exMi. oxoxe <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />E-MAIL <br />CONTRACTOR ADDRESS C TYIZIP PHON <br />CpilP.IICENSEv <br />CONTR. LICENSE # <br />L lV✓� 1 I <br />USE OF BUILDING <br />USEOF BUILDING <br />HEAT SOURCE <br />HEATSOURCE <br />COMPACT PLACE OF WORK <br />CONTRACT PRICE OF WORK <br />�.I�PX�Elfec'lrcL_Cac_OIN.� <br />Electric1_ Gas _Other <br />WORK DESC IPTION t'QOn �A, ra9La Fct51 CJ' sp 1.J12 <br />WOXY.OESC� YPOni 6An'�jL' GAP C'� 4AM1 IS <br />� J <br />PLUMBING <br />PLUMBING <br />MECHANICAL <br />MECHANICAL <br />O. ttvEKfl%NPEORREM <br />N0. � TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />— <br />Toilet <br />Toilet <br />— <br />ac-s.rewr e nrlsixr <br />A/C — air handling units <br />_ <br />emnwo <br />Bathtub <br />_Forced <br />— <br />vor�e.ir:v.+�e� <br />air systems <br />_ <br />— <br />_ <br />— <br />Lavatory (wash oazml <br />Lavatory (wash basin) <br />— <br />Gas piping <br />Gas piping <br />_ <br />sro.,er <br />Shower <br />Water heater <br />Water heater <br />_ <br />— <br />Kitchen sink 3 disposal <br />Kitchen sink 54isp¢ai <br />— <br />Gas fireplace <br />Gas fireplace <br />— <br />o�.,mem:� <br />Dishwasher <br />_Gas <br />— <br />Gas �a�c� <br />range <br />_ <br />_ <br />camw washer <br />Clothes washer <br />_Clothes <br />Clothes dryer <br />dryer <br />Water heater <br />Water heater <br />— <br />Range hood <br />Range hood <br />_ <br />_ <br />snxl�ex�mode�l <br />Sink (service/bar/mop/etc.) <br />Exhaust fan <br />Exhaust fan <br />_ <br />Pa[FNx pnanlw <br />Backflow preventer <br />Heat pump <br />Heat pump <br />_ <br />Urinal <br />Urinal <br />Unit �¢ala <br />Unit heater <br />OnrNnB Fountain <br />Drinking Fountain <br />_Boiler <br />Boiler <br />_ <br />— <br />Floor drain <br />Floor drain <br />— <br />flehgoMm <br />Refrigeration <br />_ <br />_ <br />c�.� uno <br />Grease trap <br />wooa:lore <br />Woodstove <br />Roof drains <br />Roof drains <br />_Other <br />Other <br />_ <br />OIM1e� <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />IlaeEy �O�tlllylMllMw�e&I dntl BumCMtl NI5 application enEXmwlM same tobetrue and All provisions of laws and <br />I hereby cerilify that I have read and examined this and know the same to be true and correct. All provisions of laws and <br />O�Enar�s pmmYp this lypealworkwil be mm{YI¢OviNw�o�M1Nalwpfietl M1gpn or not. iM1egMlinBdepeimilLw5nol0�esume <br />ordinates governing This type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to pre aullnnly b violet o� [e�al the provision of arty o��n elaR a level law regulating construction or p0 Po�Omante of <br />to give authority to violate or camel the provision of any other state or local law regulating construction or the performance of <br />ln':laq Yg�M 4y the ownerNNb property to OM �.��IMwN'XIo�wM1icX application is malaeMlmrtgry with the <br />construction. Thr; I ar9 aulh�ed by the owner of this properly to pertor..'I the work for which application is made and I comply with the <br />$1d q��^LKv�l�_ 29fi.MO WPC. <br />Slate C tr" yors Lacy 19.2'�RCW and 296.200 WAC. <br />�ee51SvF� o��ut50kea�' O3i� <br />$ig ure I nerlContractor/Authorized Agent ' D to <br />2— <br />