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P�RMIT APPLICATII. N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 -�U -iD <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT# <br /> .23� P:�r S� �"0.5� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION it <br /> DESC. <br /> OWNEj2 ADDRESS CITY2IP PHONE <br /> j�E�/l� 1�`�AS�1�r.5 2z1 � �; N ��-EJ�/ZFiS� �B.2���2o �-9S3-22o�, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> T QAv l� ,P lvM�:NGS�=R�`�S GGC. UD E <br /> � 1�72u�-N��•gt"'�'I �l. �NU��j 2o6 -2St'- oR2y <br /> CONTR.LICENSE It gBGrL <br /> A��—PPS 9°`i 3� �t= N Zis� <br /> USE OF BUILDING i 14, �� I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> /- / <br /> Eleciric Gas_Olher <br /> �ORKDESCRIPTION ..�.� u�u J� <br /> N:v-r G�g l•`N Fi =Ns-� �c��� ," t'1�,�. �s�.T'�CL <br /> � �1 c,� 9a�A� � w�c�rt �t«cr�- ��-�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. T�PE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> _ BathWb � Forced air syslems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower _ Water hea;er <br /> Kitchen sink 8 disposai Gas fireplace <br /> Dishwasher v Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink (service/bar/mopletc.) _ Exhaust fan <br /> Backtlow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify Ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing ihis type of work�vill be complied wi�h whalher specified herein or not.The granting of a permit does not presume <br /> lo give authority to violate or cancel ihe provision of any other state or local law reguleting consiruction or the pe�fortnance of <br /> conslruction. Tha� I am authorized by the owner of tliis property to pe�torm the wor�',�which application is made and 1 comply wilh the <br /> Stale C r ctors Law 1827 RCW and 296200 WAC. <br /> ��-,.,� ��� 3 —z-y -2or � <br /> SignaWre of OwnedConUactor/Authorized Agent Date <br />