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PERMIT APPLICATION <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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2c� ��rtw � � o�- I b <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. / ¢ jyof�5 z,ZG C�H-u/Z� �{. u4 w1oc�2e5 S L <br /> OWNER ADDRESS CITYIZIP PHONE �Z� _ <br /> rZe�� � r �� � Zc�3 G�� �' . L�e�e� z�- z�-29_ <br /> TENANTNAME CONTACTFORPERMIT PHONE (,�ZS-ZSS' Z� � <br /> S'��� �ec� �u.i�.Fr.� � E.MAIL Q�t i��Uy�e7L@� st <br /> ��ATFfAZTbk 66fz€S� PiIP—TAdR€— NeT' <br /> Gww�JN�._ /�� �/i/'C . <br /> CONTR.LICENSE R <br /> USE OF BUILDING 5� �G� r�M 1 Ly HEAT SOURCE CONTRACT PRICE OF WORK <br /> �_ ��S i qc',��.t'_ —Eledric _Gas_Other 6( � �� �� �,% <br /> l <br /> WORK DESCRIPTION ' ' <br /> ����n��� A Il'/f�wtc.'.AL to f3�.lti a� �vHsC� �rv(s���� exsis-hY-`J <br /> �P-F-�. c�., Se�<,.-r� l'C�r✓� R��LFc i•-�� /t+�✓� R C Lc�.4-�,v J Z S�R S , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OFi ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> Bathtub Forced air systems � <br /> � Lavatory(wash basin) Cas piping <br /> / Shower W�ter heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow orevenler Heat pump <br /> Urinal Unil healer <br /> Drinking Foun�ain Boiler <br /> Floor drain Refrigerelion <br /> Grease irap Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J70F <br /> 1 hereby certi(y Ihat I have read and examined this appiical�on and know the same to be true and correct. All provisions oi laws and <br /> ordinances governing this type of work will be complied wilh whelher specified herein or not. The granting o(a pertnit does not presume <br /> to give authority to violate or cancel the provision oi any other state or local law regulating conslruction or lhe performance oi <br /> construclion, hat I am authorized by the owner o is property�o perform the work for which application is made and I comply with ihe <br /> Stat Co to iC27 a AC. <br /> ,- l�� 2.� 0� <br /> � nature o 0 edCo actodA orized Agent Date �/ <br /> Z <br />