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� .. <br /> PERMIT APPLICATI�N <br /> CITY O� EVERETT PERMIT SERVICES 5 ��7;� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org �PA 0 q -O/ <br /> �b�(� APPIICATIONS ARE ACCEPTED FROM B AM TO 4 PM ��� <br /> �- <br /> SITE ADDRESS PARCEL TAX I.D.A PE IT� <br /> -IO►i PRci1y� �s1/G• oo+3'rs�t3o�t�oo ��� - <br /> LECaA LOT NO. BLOCK TRACT OR SUBDMSION It <br /> DESC. �(e�2o -�Z'3 �-} <br /> OWNER ADDRESS CITY2IP <br /> PJ(� SbaND K10N6Y GEN'fEK IObS PAcI�`I� hVfi� ��T 4L�'2i1'SIqS <br /> TENANT NAME CONTACT FOR PERMIT PHONE �.LS_Z,�9_ O�(/� <br /> ►�pr.��NKsiPJttb�.1 �VIlO\N b G1it�S.RAEf' � ' �� <br /> � �'E�MINL UM�S.<wef w'1�Y�aRY�•Qaw <br /> ��i — <br /> N6WI+iND Wa�wlct�a+ ccMP��Y ' i3oo �Wt��1'r Sf 61p�L'4'r WCS'-Z51-'1�q1 <br /> CONTR.UCENSE M . , , � � . p�q� � • <br /> USE OF BUILDING� ' I HEA7 SOURCE �" " I CONTRACT PRICE OF ORK <br /> 01-��� I _Electric ✓ Gas_Other I �14��3�A •o0 <br /> WORK DESCRIPTION <br /> W�O,� �ISc)If.AINb 1�e{� pVy�CSWND 1GItaNt'Y GEN'fGL. <br /> [��w11� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FO(TURE OR ITEM <br /> Toilel A/C—air handl�ng units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothos washer Clothes dryer <br /> Waler heater Range hoo� <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> �ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Rou(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby cerilify that I have read and examined lhis appiication and know lhe same to be true and correct. All provisions ot lawa and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permif does not presume <br /> to give authority to violate or cancel the provision of any other state or local Iaw regulaling wnstruction or the pertormanca of <br /> construction.Thal I am authorized by the owner of this propeAy to peAorm the work for which application is made and I comply with the <br /> State Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> ��' n.�/ 3!19/ 10 <br /> Signature of Owner/Con ctodAuthorized Agent —� at� <br /> ��Z <br />