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PtRMIT APPLICATIC�N <br /> CITY OF EVERETI' 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 2� S� / <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> r 3a 1 U�,�es A �c � 2-�3 <br /> LEGAL l0T NO. BLOCK TRACT OR SUBDIVISION# <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �"11acKev�z�e (�JorK /3�1 D��kPsA�e �ucrEtt- Q�I y�.5�313303 <br /> TENANT NAME C�NTACT FOR PERMIT PHONE/ I�C ��G. L/�OO <br /> I � � �.e\ �7 � � � <br /> 1'nu��tn Z� e �o f�L ��� ��- E-MAIL <br /> Z`6R�2i�A T R� `� , � /11—� D�R��$ ��IfYl21� PHONE <br /> �us+ �-� ' F�ny, i� ��i5 w�C��n� RD +�r-C,�-vrr� ya5- 3�1�-��°7 <br /> CONTR.UCENSE M r�s-j N A= I 3 1 C L �✓-b <br /> i- <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric �Gas Other � �5�� <br /> WORKDESCRIPTION���51c��� � he�..i �f�lacC��11S�1���� .:,� qaS !i rt� "�G �U�R4G� <br /> C'111A �- "4'C�' $ ir15'�q11P� �4f �k'�v.vC �i��d,aeC [11'1A W���tif�PGI�-C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C-air handling units <br /> � Bathlub � Forced air systems <br /> Lavatory(wash basin) V' Gas pipinc� <br /> Shotiver ✓ Waterheater Fw1�.v� <br /> Kitchen sink&disposal � Gas(ireplace Fk�ur� <br /> pi,h.vashcr Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(serviceNadmop/etc.) _ Exhaust(an <br /> Back(low pieventer _ Heat pump <br /> Urinal Unit heater <br /> Orinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(dr2ins Olher <br /> Other — , <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3t05 <br /> I hareby cerilify that I ha��e read and examined lhis application and know the same to be true and correct. AII provisions o(laws and <br /> ordinaces govemin�Ihis lype of work will be complied wilh whether specified herein or noL The granling of a permil does nol presume <br /> lo Uive authority to violale or cancel the provision o(any other stale or local law regulating construction or the pedormance of <br /> construction.Thal I am aulhorized by Ihe ovmer of ihis property to periorm the work for which application is made and I comply with the <br /> Slale C�Mr2clors Law 18.27 RCW and 296.200 WAC. <br /> `1�`�'� VV�(�,t.,i,d� a ����� ' <br /> Signature ol OwnedConlractor/Authonzed Agent Date <br /> �— -- -- - --.— I <br />