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PE�tMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �iU /�p��/� <br /> � � rl <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE�l I IRE q r�� ��� �� G�'�, PARCEL TAX I.D.# PF�tMIT�� � <br /> �� /,��� .� 7 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> pR� D�v�.��Pr�r�r � C�vSiYi.ua-►a�v pb. 3ox �t3Zc� �z��iii �`�8z <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Na� JnKn� oGo�Sou�/i c.�Zs - Z3Z- � `isL <br /> CONTRACTOR ADDRE55 CITY2IP PHONE <br /> CONTR.LICENSEp �,�LyCR� ZOC- <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> MuL���u'7 Eleclric Z( Gas Olher <br /> WORK DESCRIPTION \ <br /> �1/rc�V �U{�[.F� — W�."� �Z Sr"�1' l <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FUCTURE OR ITEM <br /> Toilet '' _ A/C-afrhandlingunits <br /> Bathtub i !�-� Forced air systems <br /> ,_fa_ Lavatory(wash basin)✓ �a Gas piping <br /> Shower �,� Walerheater <br /> _ � �� Kitchen sink 8 disposal Z� Gas fireplace <br /> Z Dishwasher Gas range <br /> Z Clolhes washer Clothes dryer <br /> �'YYelerneater 2 • Rangehood <br /> Sink(service/badmople' ) f; � Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Orinking Fountain Boiler <br /> Floor drafn Refrigerelion <br /> Grease trap Woodslove <br /> '�,` Roof dralns _ Other <br /> / .Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I heroby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type o(work will be complied with whelhor specified herein or not.The granling of a permit does not presume <br /> to giva authority to violate or cancel the provision of any other state or local law regulatlng wnslruction or the perfortnance of <br /> construction.That I am authorized by lhe ownar of this properly lo peAorm the work for Nhich applicatlon is made and I comply with the <br /> State Co ors�-env-3 , 7 RCW and 296.200 WAC. <br /> \ Z— �7-0(� <br /> Signature o edCon cbdAulhorized Agent Dale � <br /> l <br />