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( <br /> P�RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SER1/ICES <br /> 3200 CcDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www everettwa.org <br /> i,( N i j CS� APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT# � <br /> i�426 PkiN � t=iK lU W�`� ��vS37 ODDTJ/� � �o��� - c �i <br /> LEGAL LOT NO. BLOCI( TR T OR SUBDIV N N/J / <br /> DESC. j QL( .�,Q �P�l'o'l �� <br /> OWNER AUDRESS CITYIZIP PHONE <br /> �� KbTonl� `rso<< l8l01 � 2�� a�� �J �-Y�a��o� wA- Q8o3 ? <br /> TENANT NAME CONTACT FGR PERMIT PHONE <br /> W'T L c E�MA1l <br /> NTRA O A SS IZIP <br /> C�bblesro.�� cor�Gr r��,i�� l�c S,r� � kS koa�,� � 6�-���7�� <br /> CONTR.LICENSE p <br /> USE OF BUILDING NEAT SOURCE I CONTRACT PRICE OF WORK <br /> SC� _Eleclric _Gas�Other <br /> I <br /> WORK DESCRIPTION <br /> � �ro�y 13A� rc �y� <br /> s r P/�- 0�"-0 �`6 4o x L�- zo b'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow p�avenler _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease Irap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify that I havo read and examined this application and know lho same to be true and correct. All provisions o(laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or not.The granting of a permit does nol presume <br /> fo give aulhorily to violale or cancel Ihe provision o(any other slate or local law regulaling wnstruclion or the perlormance of <br /> construclion.Thal I am aulhorized by thn owner o(lhis property to perform the work for which application is made and I comply with Ihe <br /> Slate Coniractors Law 18.27 RCW and 296.200 WAC. <br /> � q� -� ���10� <br /> SignaWre o(Owner�/>Co tr I tor/Authorized Agenl Dale �/ <br /> Z <br />