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P�RMIT APPLICATI�,�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-wwi,v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.t P MIT/ <br /> � �o� l�e.a �-E �' �'� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP � PHONE <br /> C'hunJ.er��a �r�-i 1!u��'1 1B2y e�o,r �v.�.ne t+ C'� z�� 25z -���� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> l�S f1'la, C �'Sarri <br /> CONTRACTOR ADDRESS CiTY21P PH �+E <br /> uf.�he.l � 5i�`' 1 ���x�l�.� 2�►z �v��tt A,� sv��it, W✓�(�t�°s) <br /> CONiR.LICENSE N �a m` � !��4,�. /�� O)�72 v�/ 3,� �Z�j � <br /> . L 1 ��/2�� S j�— 31pZ <br /> USE OF BUILDING I — HEAT SOURCE I �ONTRACT PRICE OF WORK <br /> ConY�Y/ie�✓�ct �-�a c-� 2 2 J <br /> Electric ✓as Other <br /> WORK DESCRIPTION . <br /> ,,��,�U ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—afr handling units <br /> Bathtub Forced afr systams <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher . Gas range <br /> _ Clathes washer Clothes dryer <br /> Laundry tray Range hood • <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backfiow preventer Heat pump <br /> Urinal UNt heater <br /> Drinking Fountain Boiler <br /> I _ Fioordrain _ Refrigeration � <br /> Grease trap Woodstove <br /> i _ Roof drains � Other 5 f o, h <br /> Other �— <br /> � <br /> I CITY OF EVERETT LOCAL SALES SAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this applicatlon and know lhe same to be true and correct. All provisions of laws and <br /> � ordinaces goveming this type of work will be complied with whether specified herein or�ot The grantlng of a permit does not presume <br /> ! to give authonry ro viotate or cancel the pravision of any other state or local law regulatlng consWctlon or the pedortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applfcadon is made and I comply with the <br /> ; Slate Conht actors Law 18.27 RCW and 296.200 WAC. <br /> j �Y<a��ic .�,�,�' �2/��-) a 4 <br /> Signature o ner/Contractor/Authorized Agent ate <br /> ��i <br /> � <br /> , <br />