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P��RMIT APPLICATI 'l�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 S AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# / <br /> �3 I � O A�C_�2.5 SC/cp�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHON <br /> 1321 coLP�� �v,g ascY R�C�eu�Dr <br /> pRoVip�lc� MED1CAc. CL'T��F� E��S� q01(1(a LZS) 2fd-µ089 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N � s� �P�z� ��t2s� 3ti b-060� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �����J., �� �Electric �Gas_Other <br /> WORK DESCRIPTION <br /> ��,•U c.��`�, o� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 5105 <br /> � hereby cerili(y lhat I have read and examined this application and know lhe same to be true and correcL All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to giva authonty to violale or carcel the provision of any other state or local law regulating construction or the performance of <br /> construction. Th t I am authori�d by the owner of this property lo per(orm lhe work for which application is made and I comply with lhe <br /> Slale Co Law 18.7.7 R W and 296.200 WAC. <br /> , �� 3 oS <br /> Signalu e o(Owner/G uthonze Agenl Date <br />