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P'`RMIT APPLICATI�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.# PERMIT t� � <br /> 1�7 � � d/��L'�S , lj ' � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHON <br /> ��2� �o�c�y �iv,�, ArrY �c�ex,�r <br /> Prov�oa,�c MED�CA�- CS�-T1��K. 'EYr(LERq624(o CZS) 2(d-4089 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> t,� A s� �-4t�-�� ��t2s) 3ti�-0001 <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��5��� �� �Electric '�Gas_Other <br /> WORK DESCRIPTION <br /> ��.•U c�-,—1 oaa <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/badmop/etc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corcect. All provisions of laws and <br /> ordinacos governing this type of work will be complied wilh whether specified herein or not.The granling of a permit does nol presume <br /> to give aulhonty to violate or ca cel the provision o(any olher state or local law regulating construction or the performance of <br /> construction.Th I am authori d by the owner o(this property lo per(orm lhe work for which application is made and I comply wilh the <br /> Statct Co Law 1827 R W and 296.200 WAC. <br /> � C�� 3 oS <br /> Signalu e o(Owned uthonze Agenl Date <br /> � <br />