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P��MIT APPLICATId�� <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 FRO�� 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.M pE��7'/ <br /> �a3i G v�. 9�ao� i1lal� r�•�GK <br /> LEGA L07N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONE <br /> �n�`�e�,.� Cv�"•4 a�33� �',R��O Ave �vc->zriT 9Fs,2o/ �zs��'�-or6/ <br /> TENANT NhNE CONTACT FOR PEknIR PHONE <br /> �5+�< I Sv��e S�e . <br /> CCNTRACTOR N�� p�y�<<,., ADDRESS S�.�� CITY2IP S�•«u PHONE Sa+++�C <br /> CONTR.LICENSE R <br /> USE OF BUILDING I — HEAT SOURCIE I CONTRACT PRICE OF WORK <br /> Electric �Gas Other <br /> WORK DESCRIPTION /�l) 57�-��✓�r+o., G�' �.D(J j G�a S S 7vvC /.v L�L�n' ���sy/ <br /> ntu,en� wear cJx�e•. 1st f/�va. <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM NO. TYPE OF FI%TURE OF ITEM <br /> _ Toilet A/C—a(rhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal � Gas fireplaco <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry trey Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain 8oiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J705 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grantlng of a permit does not presume <br /> to give authority to vioiate or cancel the provision of any other state or local law regulatlng construction or the pertormance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br /> State Contracror La 18.27 RCW and 296200 WAC. <br /> � � D O <br /> Sign re of Ow /Cont ctor/Authorized Agent Dat <br />