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ADDRESS <br />LOT NO. <br />PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. STR�ET, EVERETT, WA 98201 <br />425-257-8810 — FA}: 425-257-85`�7 — v.v,n�r.evereth�Ja.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. � <br />U S T �5�� Z- o�/- ODO -DOD <br />BLOCK TRACT OR SUBDIVISION � <br />DESC I � <br />pWNER � A�DRESS CITYlZIP <br />�����/! f/o�i�/i✓G f �if/��ir/ S/G7 C�iz�y /'v� �✓�!'� <br />r',P; o f <br />PERMIT # <br />—� � � <br />�_ � � <br />yt.� . 3✓). /i[:� i <br />TENANT NA�dE CONTACT FOR PERILIT PHONE c�� � j G v <br />.�r�✓iicFF y2s . <br />S��y� � _ E-MA�� <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />�d� �Eii .��dr�ii� a �if/��� � j <br />CONTR. LICENSE # . <br />USE OF BUILDING <br />SF,�' <br />HEATSOURCE <br />Electric ��as _ Other <br />CONIFfAGI Yhci�.tvrvvvnn <br />(�;Q� <br />WORK DESCRIPTION <br />,,����I/,�/���i��G�� �XifT�'✓G .���/G�/�"� <br />PLUMBING <br />N0. I TYPE OF FIXTURE OR ITEh1 <br />Toilet <br />Bathtuh <br />Lavatory (wash basin) <br />Shower <br />Kiichen sink & disposal <br />Dishwasher <br />Glothes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />Back9ow preventer <br />Urina� <br />Drinking Founlain <br />Floor drain <br />Grease trep <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITE�n <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />6oiler <br />ReFrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certity that I have read and examined this application and know the same to be true and correcl. All provisions of laws ar�d <br />eidinances goveming this type of work will be complied �vitn whether specifed herein or not. The granting of a permit does nol presume <br />io give authority to violate or cancel the provision of any olher slale or local lava regulating construction or lhe performance of <br />constru ion. That I am authorized by the owner of this property to pertorm the work for wyich application is made and I comply with the <br />s„in C'�rarlors Law 1827 RCW and 296200 WAC. <br />Il�lb� L��2 <br />