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PE� r2MIT APPLICATION <br /> �ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> �� �,; � � /.� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.O.# PERMIT if <br /> i� lz6 Pk�N � r�� �u w�Y :�1�53� ODDd/� v c ����-O�a� <br /> LEGAL LOT NO. BLOCK TR �R�DIV N N� �^ <br /> DESC. � �{�� o� <br /> OWNER AD�RESS CITYIZIP PHONE <br /> � I<bTU/�C�' `(3otc 18io ► � 2�H a�� t,� �-y� c��c� w�- Rgo37 <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> W� L� E-MAIL <br /> NTRA TO A RESS Yf'��AbF1�— <br /> C,�bv►esTon�� cor�Grz r�e7,��..s �(e �,�wr � �-.r kpaa� 206�226-4-7�� <br /> CONTR.LICENSE N <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> SC� _Eieclric _Gas](Other <br /> � �. <br /> WORK DESCRIPTION <br /> � �to�y 1�H� lc �ya� <br /> S r-p/� 0�"-o �'6 4v X L�- Zo �-6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C–air handling unils <br /> Bathtub _ Porced air systems <br /> Lavalory(wash basin) �_ Gas piping <br /> � Shower ( Water heater <br /> � Kilchen sinY.&disposal � Gas fireplace <br /> i Dishwasher Gasrange <br /> � Clolhes washer � Clolhes dryer <br /> � Waler healer 1 Range hood <br /> Sink(service/badmop/etc.) � Exhausl fan <br /> _L Backflow prevenler Heal pump <br /> Urinal � Unit healer <br /> Drinking Fountain _ Doiler <br /> 1_ Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> � Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby ceritify Ihat I have read and eramined this applicalion and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces governing this rype of work will be complied wiih whelher specified herein or nol The granting of a permit does nel presume <br /> to give aulhority to violale or cancel the provision of any other stale or local law regulating construction or lhe periormance of <br /> construction.Thal I am authorized by the avner o(Ihis property lo pr.rtorm the work for which application is made and I compty wilh Ihe <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. / <br /> 'l!�-l�� �1/�-= " 61�'l o� <br /> Signalure of Ovrner/Co�lre Ior/Authoiized Agenl Date � <br /> � L <br />