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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —vaww.everettwa.org <br /> l.'�ti / � F,� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.1{ PERMIT p ' / <br /> i� iz6 Pk�N � r-��. �� wa�r ov.�`3�9oDo��ao _ ����c�-��t;� <br /> LEGAL LOT N0. BLOCK TR/c�T�OtR�DIV N#� �� <br /> DESC. Ja �� Y� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � (<o7'on1� `isoi� 18�01 � Z�� bv� W W� {�kJ� w� Q$�37 <br /> �ENANTNAME ( CONTACTFORPERMIT PHONE <br /> �'T L� E-MAIL <br /> T OR S / NE <br /> (�bblesron�E �or�Gr rfa���?�� ((� �,�vr � ks ,�p��,� 2e� 6^"�-47�� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRAC7 PRICE OF WORK <br /> SC� _Eleclric _Gas]( Olher <br /> � >. <br /> WORK DESCRIPTION <br /> 3 �fib�y 1�A�� � c �y� <br /> q-o X Zy- zo �6 <br /> s r P�- O�� —U ��6 MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> Toilel A/C—air handling units <br /> 6athlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrangc <br /> Ciolhes wasV r _ Clothes dryer <br /> Water heatei _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Driaking Fountain _ Boiler <br /> Floor drain _ Refrigerelion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other — <br /> CITY OF EVERETT IOCAL SALES TN(CODE IS 3105 <br /> I hereby ceriti(y thal I yave read and examined this appl�cation and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this lype of work will be complied wilh�vhether specified herein or not.The granting ol a permil does nol presume <br /> to give aulhonty lo violate or cancel the provision o(any olher slate or local law regulating construclion or the periormance of <br /> construction.Thal I am authorized by lhe owner of lhis property to perfonn the work for which applicalion is made and I comply wilh lhe <br /> Slale CoNractors Law 18.27 RCW and 296.200 WAC. <br /> i,�,—t� �,� - 6l�ro� <br /> Signalure o(Ownr/Co tra todAulhorized Agent Date i/� <br />