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P�RMIT APPLICATIC.►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& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PER�11T# <br /> �`���,�—E �A�7Z S � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHON <br /> �32� co�c�y �v,�, AcTY �c,ecc�Dr <br /> paov�o�-.--r�c� MED1 CAc. C�x��. �v--2� 9�wco LZS) 2fd-4o89 <br /> TENANT NAME CONiACT FOR PERMIT PHONE <br /> t� �a sT� �-4 p-c-��R (42s) 3y �-0601 <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BU�LD�NG HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��s��-� p�� �Electric '�Gas_Other <br /> WORK DESCRIPTION <br /> ���•U G.4�"'�, O/�1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 3 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ciolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/elc.) Exhaust(an <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceriti(y that I have read and examined this application and know the same lo be We and correcL All pmvisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to c�ive aulhoriry to violate or ca cel lhe provision of any other slate or local law regulatinc�construction or the pertormance of <br /> conslruclion.Th I am authori d by the owner of lhis property to perform the work for which application is made and I comply with the <br /> Slate Co Law 18.27 R W and 296.200 WAC. <br /> � Cp� 'j OS <br /> Signalu e of Ovmer/ � uthonze Agent Date <br />