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PE�2MIT APPLICATIO� <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 /> L� /� i T I°� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N F�ERMIT# <br /> i� 126 Pk�n� � 1=��. 1D WA-`r -'�US37 ODodi� o cr GCo - D J� <br /> LEGAL LOT NO. BLOCK TP �R�DIV N M� �^ <br /> DESC. � 'fil/ o� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �� I<bTOI�C�' `T3olc 18io ► ( Z�H bU� �J c�{� ��oa� w�- Q8�37 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> W� �" E-MAIL <br /> p R SS CI I I O <br /> C.obblesTo�� �r�Gr l/v����,5 l(e. �,�wr � ,�-.r kpa�,e Zo6��-47�� I <br /> CONTR.UCENSE p � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> SG� _Eleclric _Gas_�(Other <br /> � ,. <br /> WORK DESCRIPTION <br /> � �ro�y l�� ic �y� <br /> s_r- P/�- a�l-o�-G 4o x zy- zo �6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ A/C-air handling units � <br /> 6alhWb _ Forced air syslems <br /> Lavatory(wash basin) �_ Gas piping <br /> = Shower 1_ Water heater <br /> �_ Kilchen sink 8 disposa� _(._ Gas tireplace � <br /> � Dishwasher � Gas range � <br /> � Clothes washer � Clolhes dryer <br /> �_ Water healer ,� Range hood <br /> Sink(servicelbadmop/elc.) � Exhaust fan <br /> T BacY,flow prevenler Heal pump <br /> Urinal � Unil healer <br /> Drinkiny Founlain _ Boiler <br /> _1 floordrain _ Refrigeration <br /> Grease trap _ woodstove <br /> � Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this application and know the same to be lrue and correct. All provisions o(laws and <br /> ordinaces goveming tliis type of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> to give aulhorily to violate or cancel Iho provision of any olher stale or local law regulaling consWction or the pertormance of <br /> conslruclion.Thal I am authorized by Ihe owner ot lhis property lo periorm the work tor which appiicalion is made and I comply with lhe <br /> Slalc Contractors Law 18.27 RCW and 296.200 WAC. <br /> i�—�'� il�-= - 6l�l a� <br /> SignaWre o(OwnedCo tra lor/Authonzed Agent Date i/ <br /> Z <br /> � <br />