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% <br /> P�RMIT APPLICATI�iN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org � <br /> ��3� � AP?LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P� I�� -� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT M <br /> . C,b4(eta IaZZ 5tt� �c7C7 � �CI� ' S <br /> IEGAL LOTNO. BLOCK TRACT /� <br /> DESC. 4 �jC. 225 ��'h� I�ie'tdh� /-idd.'ho�.. -1-0 �a.rev�e.'�� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �CO�a��G�jG('g'� �—\�C�a/ L�b20 S�{� y�r. �� ��wr�. 7o�� V����� _ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ►� I A �,w �,� �� � <br /> CONTRACTOR DQ,�',�� Cpy��. ADDRESS CITY2IP PHONE <br /> CONT^..LICENSE il /�_/� �� ��� 104 K'3 <br /> v^+� <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF WORK <br /> � lU 10 .✓' _Electric �s_Other �SO� <br /> J �wT <br /> WORK DESCRIP ION a ��� � <br /> � � C�� � �� ��� ��� ���,� <br /> � � ✓�N�.� <br /> ti <br /> PLUMBING MECHANICAL , <br /> NO. TYPE OF FIXTURE OR ITEM HO. TYPE OF FU(NRE OR ITEM <br /> Toilel AIC—air handling unlls <br /> Balhlub y Forced air systems <br /> _� Lavatory(wash basin) Gas piping <br /> � Shower "� Water healer <br /> �_ Kitchen sink 8 disposal L Gas Tireplace <br /> J� Dishwasher ____ Gas rango <br /> _� Clothes washer �' Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar(mop/etc.) � Exhaust tan <br /> �— Back(low provenler � Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES T/V(CODE IS 1105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same to be true and cortecL All provisfons of laws and <br /> ordinaces govemin�lhis lype of work will be complied wilh whelher specified herein or not.The granting of a permil does nel presume <br />� lo gi•.e authority to violale or cancel lhe provision o1 any olher state or local law regulating construction or the performance ol <br /> conslruFlion.Thal I am aulhorized by the owner of tliis property to peAorm lhe work tor which applicalion is made and I comply wilh the <br /> Slato,qO t ac rs Law 18.27 RCW and 296.200 WAC. <br /> / <br /> <ti/ �✓' eZ//O� <br /> Sic� aturo of OwnedContractodAulhorized Agent Date \ /� <br /> � � <br />