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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.# PF,.�iMl # <br /> I LL�1 !�F-AaD r1Vc pc�t�9 LLSoc�ioa ; pc� o' �u2bCo �� �o�-n�i� <br /> LEGAL LOT NO. BLOCK THACT OR SUBDIVISION N <br /> DESG �� � , Z� 7� �y5' GNv6-�-N �tp �a-nnoo�e S <br /> OWNER ADDRESS CITYlZIP PHONE <br /> peN PNO .}Z LE`�InI !3���� +��„�� ��T�U �",v �c�tT 9�z�3 yt� vSZ. N3l'i <br /> TENANT NAME CONTACTfOR PE IT PHONE '3�U G'��-/) -3��(�/� <br /> �(� Y <br /> / ��/IL ���� Ui�� E-MAIL <br /> �NTRA T R ADDRE ITV21P PH E <br /> � <br /> CONTR.LICENSE p I�> <br /> USE OF BUILDING I — HEA I SOURC[ I CONTRACT PRICE OF WORK <br /> 1'�S i�>�C � Elec�ric �Gas_Other <br /> WORK DESCRIPTION !� <br /> t�F�.�c��c�o,,� A�ID Nt w rzesi��Hi� (r.vi7w�71i��1 371d <br /> c/y j <br /> Cl��(� �'t� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet �� \ NC–air handling units <br /> L Bathlub 1 � t Forced air sys�ems � <br /> � Lavatory(wash basin)� I 4 \ � Gas piping <br /> �_ Shower i\ � Waler healer I <br /> � Kitchen sink&disposal � � Gas fireplace <br /> � Dishwashcr � � Gas range <br /> � Clothes washer� � Clothes dryer 1 <br /> � Watcrhealer Range hood � <br /> _�_ Sink(serviceNar/mop�etc.) � Exhaust fan � � ' � � � <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain � Relrigeration <br /> Grease trap Woodstove <br /> Roof dr:.;,�> Olher _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have r and examined Ihis application and know the same to be irue and correct. All provisions ol laws and <br /> ordi ces go rning iis typ 1 work will be complied wilh whelher specilied herein or not.The granting of a permit does not presume <br /> to c�rv aulhor ty to v la�e o c nc the provision ol any other slate or local law regulaling construction or the perfo�mance oi <br /> constr ction, hat f i auth r�z Ihe owner of Ihis property to perlorm the work lor which application i�made and I comply with Ihe <br /> S�ate ontttfqors La 182 R nd 296.200 WAC. <br /> I I - <br /> �+ `� l.Y G�Si <br /> Signa ure of Ownc�dCont actodAuthorized Agent Date <br /> � ��Z <br />