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P�RMIT APPLICATIG�� <br /> CITY OF EVERETT PERM�T 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 �� �CYJ3 - 603 <br /> SITE ADDRESS PARCEL TAX I.D.fl PERMIT# <br /> �u8o8 bW �P�c �t - oo3q2 ��o3cx� :o C ��U3 `f�Ca <br /> LEGAL LOT.�NO� . BLOCK TRACT OR SUBDIVISION p <br /> DESC. ,�? Ft- 3 tl/d2l` NILIS il1lS16+'7 � �� ��� ' v� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> Yz7" <br /> G./�uc��t�✓n 1-���5 �� f'° r�� 8y6 c:.4r-E �'-�.wer5 u1w Sb155 a5� ���"7 <br /> TENANT NAME I CONTACT FOR PERMIT .. PHONE <br /> y2f'3SG -/'7l. 7 <br /> S<.� (�-yq,Gr3r S E•MAIL <br /> ���� $ 'TY21 <br /> 5 ���� <br /> CONTR.LIC[NSE p <br /> L�I�l:L1iL uo� J�— �6Z o2Z b� 3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> S�—� _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> L'ch'�I'TiC.,CT��r� OF W Z�S'7 L�/ S�✓L <br /> �C'�/c� _��� i <br /> �o u LI <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> j Toilet A/C -air handling units <br /> 6alhlub 7� Poiced air syslems <br /> �,_ Lavalory (wash basin) `� Gas piping <br /> � Shower � Waler heater <br /> �._ Kitchen sink 8 disposal _L Gas liieplace <br /> I Dishwasl'�er _L Gas range <br /> _L Cbthes washer ' Clothes dryer <br /> %.1. Waten c�ater 1 Range hood v <br /> � Sink (servicelbadmop/etc.) � � Ezhaust fan . <br /> E3ackflow prevenlcr Hca� pump <br /> Urinal Unil heater <br /> D�inking Founlain Boiler <br /> Floor drain Rehigeralion <br /> Grease irap Woodstove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby certity Ihat I have read and examined this application and know the same lo be true and correct All provisions of laws and <br /> ordmances govermng this type ol work will be complied with whether specified herein or not. The granting ot a permit does nol presume <br /> to give authonty to violate or cancel �he provision of any other slate or local law iegulating construclion or the periormance of <br /> construction. That I am aulhomed by Ihe owner of this property lo periorm lhe work!or which application is made and I comply wilh the <br /> S�aie Contradors w 1827 RCW and 2�6200 WnC. <br /> . <br /> —�( � �o � <br /> Signature of wnedConlractodAulhoiized Agenl Date i <br /> �� <br /> � -�� � ��a>> � �I <br /> �- -- - - - -----— <br /> -- ---� <br />