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S' � � <br /> �,2dDyb7o7S%�12 p�C,.�MIT APPLICATIC�,�J <br /> TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PER T�1 <br /> �� '� 2� <br /> S3 ' �L � oo� � 9c�avvv ?o ��" <br /> LEGA LOT NO. BLOCK TRACT � t <br /> DESC. /�B��S V r�PW S � �ar+� U <br /> OWNER ADORESS „9 CITY2P PMOR�2L .LUbl e.l.( <br /> IJE�vn. iS l7"• �R�SD.v 5.7 � f�c E�r� 9�03 1Y7 7F�2M <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �yL2 � D�( <br /> ��-/eN, r's C''��rLso,� 1Je N.,.i s �� �?L s u.� Yz s' ? Y7 3kTz <br /> CONTRACTOR ��e�,,,�iS � C��/I�sow� �DRESS CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDII�G __' I — HEAT SOURCE I CONTRACT PRICE OF WORK _ <br /> q�A� �i�� / � �' Electric �Gas Other ��-��//V <br /> WORK DESCRIPTION <br /> �_/�,��t,��c���C2P.�t;�� �L�-�'.'�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> �' 3 Toilet � AIC-air handling units <br /> "' 2 Bathtub ''' � Forced air systems <br /> (�_� Lavatory(wash basin) ^t'l/ �. Gas piping <br /> Shower � Water heater <br /> � Kitchen sink 8 disposal .� Gas fireplace <br /> Dishwasher Gas range <br /> � Ciothes�;ashar ,L, Clothes dryer <br /> Laundry tray __�_, Range hood <br /> � Sink(service/bar/mop/etc.)/ 7�,., Exhaust fan /���� <br /> T Bac!:11ow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrir,eration <br /> Grease trap Woodstove <br /> Roof drams Othar <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritity that i hacc read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this h•pe of work will be complied with whether specified herein or�ot.The granting of a permit does not presume <br /> ito give authonty to violate cr cancel the provision of any other state or local law regulatlng construction or the performance of <br /> construcUon.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrartors Law 18.27 RCW and 296.200 WAC. <br /> ���!-%>tnv_� �7_ �`L�CY.7v. �//U U% <br /> � Signamre of GwnenContracror/Authonzed Agent ate� �'.L <br />