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P�ERMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-wwv��.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAl(I.D.# PER # <br /> /Od8' Cr�nal �1✓ O s �".S �12I3�J Zov —.� <br /> LEGA � LOTt�I S BLOCK TRACT <br /> DESC. I�� Z I�dl`I�i{'+- 2i 3 j� A� �E.'�5 R97 'f° �-,-�'r4��cT <br /> OWNER ADDRESS CITY2IP PHONE <br /> 2ay Ke<<szy �� os G�.��d .'�ve� E��•�If yzs zss- a�� 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �.ay ��c�s�� C�s� 2ss � ��.� <br /> CONTRACTOR ���S,r� ADDRESS CITY2IP PHPNE <br /> STGu'7�v� c�cTiv,v d'/L �oifa�e Sf /�/.'�i�,� �7IS 2�a -��o6 <br /> CONTR.LICENS�N ,��TEw/a C y� 97�ws /�}�//�O� %�Z2� <br /> USE OF BUILDING NEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,Qt y;��,��� .�Electric _Gas_Olher /Ui 00 0 <br /> N'ORKDESCRIPTION ��D� ,� �' Z/ � «M'� �µ� �n /C,'�}c{�n [,.+.f �f uS��•�� <br /> f-l�e h.;S.K.rt� F/ou� To�':�-S �o Se�,b on f-� 1-or Ca�-Fe%ve/' <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> ,� � Kitchen sink 8 elisnosal Gas fireplace <br /> � .X Dishwasher _ Gas range <br /> C�othes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopi�: � 1 Exhaust fan <br /> Backflow prevenler Neat pump <br /> Urinal Unit lieater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> �hereby ceritify lhat I have read and examined this applicalion and know the same lo be true and correct. All provisions oi laws and <br /> ordinaces governing this type of work will 6e complied with whether speci(ied herein or not.The granling of a permit does not presume <br /> to c�ive authority lo violate or cancel the provision of any other s;ate or local law regulaling consWction or ihe pedormance of <br /> construclion.That I am authorized by Ihe owncr of this property lo perform the work(or which application is made and I comply with the <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> .���tl /�' � /� �$/23`u6 <br /> Signalure of O�—� wnerlContractor/Authorized Agenl D te 1/Z <br /> _� <br /> � <br />