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PtRMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 – FAX 425-257-8857 –v,rwvd.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /b —S— O� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# _ <br /> Il�lO PALM ,4�/�- �o5317po 3oZ2o3 � ��� - /3 <br /> LEGAL LOTNO. BLOCK ,1TRAqCT p/�p� <br /> DESC. �J N` V�V• [I'-i�_ <br /> OWNER ADORESS CIN2IP PHONE <br /> STEVE fiAMO� MAR llt�l 1�10 YAc.M AVE ��• 425-Z�9-�OoS <br /> TENANT NAME i CONTACT POR PERMIT PHONE <br /> � I <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENS[# /���/� /�/J 1�� <br /> lJliV�/ <br /> USE C1F BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK I <br /> s��� Eleclric _Gas_Othcr I <br /> WORK DESCRIPTION � <br /> A�D UZ3 Sst•FT L\VINy i l3o SQ • Ft• �Ec.-+�- . � � ,��zz � <br /> �4I�' '" Y 22' ,_- --- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEA1 N0. TYPE OF FI!CTURE OR ITEh; <br /> Z Toilel _ A/C—airhandlinc�unils ' <br /> � Bathtub _ Forced air systems II <br /> � Lavatory(wash basin) Gas piping I <br /> I � Shower � Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace i <br /> Dishwasher Gasrange <br /> � Clothes washer � C!olhes dryer ; <br /> �I � Water healer Ranc�e hood I <br /> Sink(servicc3/bar/mop/etc.) 3� Exhaust fan I <br /> I _ Backflow preventer _ Heat pump <br /> � _ Urinal _ Unit healer I <br /> I _ Dnnking Fountain _ Boiler <br /> � Floor drain _ Retrigeration I <br /> Greaso trap _ 'Noodstove <br /> I Rooi drains _ Othor <br /> � I Other = I <br /> r — � <br /> I CITY OP EVERETT LOCAL SALES TAX CODE IS 7105 � <br /> i <br /> I hereby ceritity Ihat I have read and ezamined lhis app�ication and know the same lo be true and correcL All provisions of laws and I <br /> ordinaces governing this type ofµ•ork wi�l bo compiied wilh whelher specified herein or nol.The granting ol a permit does not presume I <br /> I' to givo aulhority to viotate or cancel Ihe provision o1 any other s�ate or local law regulating wnstruclion or lhe pedormance of <br /> I� construclion.Thal I am aulhorized by lhe owner of lhis propeAy to perlorm Ihe work for which application is made and I comply with lhe <br /> S�atc tra�����'•f 27 RCW and 2�J6.200 WAC. I <br /> '� �� ia�a� � <br /> SignaWre of OwnedConlractor/Aulhoraed Agent Date I <br /> '/z i <br />