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PtRMIT APPLICATILN �� .��17 c,�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �C 7Q���� <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> /3- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /�� —� � <br /> SITE A DR�3S�� ��,�f PARCEL TAX I.D.# P RMI <br /> � - Q�4Id3lDZ,z._ �tY� t c�C� � 7CJ� ' S <br /> LEGAL LOTNO. BLOCK TRACT /� <br /> DESC. �Q �� 2Z5 �rt"h� 1�le�^�'� /-aC��,'ho�... �o �v�P�+�C� <br /> OWNER ADORESS CITYIZIP PHONE <br /> �co�[--�fy�a�qcm-'t� i-\�..c�.a..s�✓ dbzo 6r1+'`��- O.J� �MG+'� • �f��� �2T33�� <br /> TENANT N�EI ^ CONTACi FOR PERMIT �� PHONE <br /> ��a ��l uu �� � �l� � <br /> CONTRACTOR OG�'t IJ� COJ�, ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# �A �� ��' 104 K'3 <br /> N, <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� _[lectric ��s_Olher � �50 ��� <br /> WORK DESCRIP �ON —� <br /> I , � a 9�� � <br /> �n � � � � � �y� ���� <br /> ��'` `� '�"`� <br /> PLUMBING MECHANICAL �~ <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl // A/C–air handling units <br /> BalhWb // Forced air systems <br /> Lavalory(wash basin) �Tr//�� Gas piping <br /> Shower ��r� � Waterhealer <br /> Kitchen sink& disposai Z G2s fireplace ii <br /> _ Dishwasher Gas range <br /> Clolhes�vasher � Clathes dryer <br /> Waler healor � Range hood <br /> Z Sink (service/bar/mop/elc.) � 1� Exhaust(an �Y,(j 1 <br /> Backllow provenler Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerili(y Uiat I have read and examined this applicalion and know the same to be lrue and correcL All provisions oi laws and <br /> ordinaces governing lhis lype o(work will be compliod with whether specified herein or noL The granting of a permit does nol presume <br /> to give aulhorily lo violale or cancel the provision of any olher slale or bcal law regulalinc�constructior.or Ihe podormance of <br /> conslru lion. That I am aulhorized by ihe owner of lhis property to peAorm lhe work for which application is made and I comply with the <br /> Slato � c rs Law 18.27 RCW and 296.200 WAC. <br /> � � <br /> t.�/ "J!s[/�O�'I <br /> Sig alure of Own�dConirectodAulhorized Agenl Dale <br />