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� � <br /> PtRMIT APPLICATIUN <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 /> �i/� j T � APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA7(I.D.# P RMIT N <br /> ? <br /> ii12G Pkw � r�� lp wA�r �JS37 Ol,���/-� C-� �Ofa - �—, <br /> LEGAL LOT N0. BLOCK TR T OR SUBD�V N N� � <br /> DESC. �� �jGf �.P �C�/ � <br /> OWNER ADDRESS C�TY21P PHONE <br /> �� 1<c: jen�� 'TScic I £510 ) � ZTN A�� 1,�..> (�yi1 ;1w'cu� Wh Qg� 57 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> W/+ L � u� -4+�C- - IZ13 <br /> E-MAIL <br /> TRA T . A D I I I <br /> i �!�{'_' <br /> (�-�1�l�le � ��i��_ rx�Tl�Gr rh���t� (�c S,G�v� � �r kl3c �� ?�c, 6� �z2G-47�� <br /> CO�!?R.LICENSE p <br /> USE OF BUILDINf; HEAT SOURCE � CONTRACT PRICE OF WORK <br /> > C('' I _Eleclric _ Gas Other I <br /> / <br /> WORK DESCRIPTION <br /> � <br /> .� s��� y �,� � � ��y� <br /> SriP� U �" - C> >'G a-[; XLy �od1C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF�FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel lVC—air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer _ Clolhes dryer <br /> Water healer Range hood <br /> Sink (servicelbar/mop/elc.) _ [xhausttan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Other_ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify lhat I have read and examined lhis applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming Ihis typc o(work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authorily to violate or cancel Ihe provision ol any other state or local law regulaling construction or the peAormance of <br /> consfruclion.That I am aulhorized by the owner o(lhis property to periorm the work for which application is made and I comply with the <br /> Stale Conlraclors Law 1827 RCW and 296.200 WAC. / <br /> ���a _j t�' l,�-- � 6l 2=- � 0 7 <br /> SignaWre ol OwnedCo Ira lor/Aulhonzed Agent Date <br /> I�Z <br />