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P��RMIT APPLICATIt�N <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> i <br /> I`��O Co O��Ci.S <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHON <br /> i32i co�c�sy nv,� ACTr �c,ex�r <br /> P2o�ltO�C.� MEDICA�. CLT1�E�.. �Y�ft�l' q�14(o �ZS� 2fd-4089 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> t� �i s�� �4P.c-��R ��t2s� 3y �-000-► <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR LICENSE# <br /> USE UF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ������� pY� I �Electric '�Gas_Other <br /> WORK DESCRIPTION <br /> ��•U c�,--t, oa.1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTUYE OR ITEM NO. TYPE OF FIaTURE OR ITEM <br /> Toilel NC—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash ba:cin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer C�othes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mopfetc.) Exhaust fan <br /> BackOow preventer Heatpump <br /> Urinal Unit heater <br /> Drinkinc� Fountain Boiler <br /> Floor drain Retrigeration <br /> Grease trap Woodstove <br /> Roo(drains Olher <br /> Other <br /> CI1Y OF EVERETT LOCAL SALES TIUC CODE IS J105 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveminc�this rype of work will be complied�vith whether specified herein or noL The granling of a permit does nol presume <br /> to give authoriry to violate or capcel the provision uf any olher state or local law regulaling wnstruction or the performance of <br /> construction. Th I am authori�ed by the owner of this property to perform the work for which application is made and I comply with the <br /> Stalo Cor Law 18.27 R�W and 296.200 WAC. <br /> Cp13 os <br /> ; Signatu e o(Owned uthonze Agent Date <br /> i <br />