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PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM �p —3 p_.� <br /> SITE ADDRESS PARCEL TAIC I.D.t � <br /> 1905 3 �'w� rT a�E Oo'/ �9/ �� yo iiov <br /> LEGA LOT NO. BLOCK TRACT OR 6USOMSION• <br /> oEs�. �� � �a ��y v -o0 <br /> OWNER ADDRESE V1S�T7 <br /> pE rER N s�Ko� �'o �DX Zz z�� s�+rr� wr, ���: <br /> TENANTNAME CONTACTFORPERMR PMOME �(�rj iZS7 .ZOW <br /> �R6v WtwDro/a I W�+�s w�teR 1�� �b,R �NMeOw+atwr . <br /> (/dAdl►VK+L� /W E�ANL � <br /> CONTR.UCENSE• �/� <br /> USE OF BUILDING HEAT SOURCE NIiiAAo�PWCE OF WORK <br /> I — M�lKw►�- <br /> �ZET/.lL / O�rl[.E Eleclric ✓Gas_Other I'y�.�s <br /> WORK DESCRIPTION ��� � <br /> NNv4 - Mv0 � '77�Pd - �IQ.iM6 - �tNT K f��Tf <br /> SME'd'T Rou�c Onl C/N��V /w �~ <br /> 13r►?D7MCKT SMG� . r ,�s't�,Z.s� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower VYaler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer CloMes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) _ E�austfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heator <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratlo� <br /> _ Grease trap Woodstove <br /> Roof drains � Other S��T ROC.K <br /> Olher <br /> CITY OF EVERETT LOC/LL SALES TAX CODE IS N05 <br /> I hereby ceritiry that I have read and examined this applicadon and know the same to be true and correct. All pmvfsions of lews and <br /> ordinaces goveming this type of work will be complied wilh whelher specffied herein or not.The granting of a pertnil does not presume <br /> lo give authorily lo vialale or cancel e provision of any other st2te or local law regulatlng consWcBon or the pettortnance of <br /> construction.That I a a Ihorized the owner oi this property lo peAorr.i the wark tor which application is made and I comply with the <br /> Stale Contractors w 1 .2 C nd 296.200 WAC. <br /> �-�- 6 z� aF <br /> Signalure o( t r/A horized Agen Date <br /> l� � S <br />