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PtRMIT APPLICATIUN <br /> CfTY 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 TN(I.D.� PERMIT# <br /> I -' Z(-� ��,� ,� �l�12 � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> J1/Ic1r�� �v��L i3�z� G��,�� .h� (:�E�f 9Pi?ol 'iz5-2.zo-6 S <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ���, '. <br /> �, <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> iJ�� /]�J <br /> CONTR.IICENSE# �/ �'✓"' <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric �Gas_Olher <br /> WORK DESCRIPTION <br /> ,L�°�t�Lll bnth �b/b�i���.efj �tu�le•r, �;:�s� la.s1� � �'..,n ;�1 �� raow� YIo•� c:��K,,:� <br /> U'-i¢C� �Lc� r� �0�.`4N.vvJrN. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � �C Toilet A/C–air handling units <br /> �� Bathlub _ Forced air systems <br /> i C Lavalory(wash basin) _ Gas piping <br /> , X Shower _ Walerheater <br /> Kitchen sink 8 disposal _ Gas firepiace <br /> Dishwasher Gasranga <br /> Clothes washer Clothes dryer <br /> Watcr healer Range hood <br /> Sink (service/bar/mop/etc.) �� Exhaust(an <br /> BackBow preventer _ Heat pump <br /> Urinal Unit he2ler <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that 1 have read and examined this application and know the same to be true and cortect. All provisions ot Iaws and <br /> ordinaces c�overning lhis lypo o(�vork will be complied with whether specilied herein or noL The granting of a permit does nol presume <br /> to give authorily to violate or cancel the provision of any olher stale or�ocal law regulaling wnslruclion or lhe performance oi <br /> construcfion.That I m authorized by the owner of this property lo perform the work(or which application is made and I comply with the <br /> State ConUa tor�w)18.2 and 296.200 WAC. <br /> �� � lV' /r.��� �Z���vl� <br /> Signa ure of�er/COniraclorlAuthorized Agent � Date <br />