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P�r�MIT APPLICATIG�J <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.# PERMIT N <br /> 310f UNKS Rd,� pp 34e7 �(oo2goi �ayl0-O!Z <br /> LEGA LOT NO. r.J, '70� BLOCK TRACT <br /> DESC. �H_ 2'�, .30 <br /> OWNER AODRESS CITY2IP PHONE <br /> �CRR�ni 6kAr�F�r� 3101 o�+�S �+�E f.E�en- yszc� 42r 33y i33 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> /t5%IGoCK W1�.1- L RkW) 4LS So I 3SY3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> 1,� i6(c fz�i . (N�. 57IC 46r�. A�E N.�. �akettis�a�E �8'-70 3Go �S3ulY <br /> coNrt+.uceNsex y�l•a�E:L-1��j3?3l} <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> OFFIC�j �,Eiectric Gas Other ��`, b00.00 <br /> WORK DESCRIPTION <br /> RE-xo�F <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR iTEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/etc.) Exhaustfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Bolle� <br /> Floor drain � Refigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> ! Other <br /> � CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> iI hereby ceritify that I have read and examined this applicalion and know the same to be true and cortect. All provisions of Iaws anC <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grantlng of a permit does not presurt:e <br /> � to give authonty to violate or cancel the provision of any other state or Iocai law regulating construction or the performance of <br /> I construction.That I a authorized by the owner of this property to perform the work for which applicallon fs made and 1 comply with the <br /> Sta�/ �ontract�rs L���1827 RCW and 296.200 WAC. <br /> � Lu(;i�i ,J q—Zy- oV <br /> I Si�nature of OwnedContractor/Authonzed Agent Date i/Z <br />