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( <br /> PERMIT APPLICATION <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 � —� —�Fj <br /> SITE ADDRESS PARCEL TAX I.D.M PE�y IT N <br /> � 'x^ � . -i�C AI/ . ooy 3�o ��vo/ono ( 'G%C%7-��1� <br /> LEGAL LOTNO. BLOCK TRACT <br /> D[SC. � �y <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 130o Z - �y� 5r � �•� � . 3�� — <br /> STCti c �A I/v 2 /�Z= ��,r_�- sas�s w� ��z S� �-,�� � � �Y <br /> TENANTNAME ���iy� j' CONTACTFORPERMIT T— PHONE <br /> c/t�G,� l+/16�17'� — �/•°/S/f6vG <br /> .J`: LL/. C. �'�v1�2ioivS lNc. • ��sac�,4-�1�' yzs' �_ s39y� <br /> CONTRACTOR r f��y� „Z—�yQ�j���j��ADORESS CITYIZIP PHONE <br /> ao9N Z �� 74s�`5l• �" <br /> CONTR.UCtNSE�I �ZS`�'O � � <br /> NO i?- I" 6-2�ru�iv0 � �/�'uJ' 3 <br /> USE OF BUILDING �IUi�ti � HEAT SOURCE COMTRACT PRICE OF WORK <br /> �9/'j /n,'L�/� �/�/5yl'il/ I _Electric �Gas_Other \�C�,(�L�� � <br /> , <br /> WORK DESCRIPTIpN ,Q d U C(%�vl� U�2 S S <br /> ����-t�1�l��.,� ��' G���tvl� s�'/�-�� n� , � �' <br /> f /�i2 ►M��E i��� ��,,-� l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE 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 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal UN[heater <br /> Drinking Pountam _ Boiler <br /> Floor drain Refngeration <br /> Grease trap _ Woodstove , <br /> I = Roof drains � Other ��� '���� <br /> Other �%'"�— ��� <br /> � fN/l iM�J f ��_ <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3705 <br /> I hereby ceri6fy that I have read and examined this application and know the same to be true ana correct. All provisions o(laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property ro periorm the work for which application is made and 1 comply with the <br /> State ContryU s Law 1B 27 and 296200 WAC. <br /> i <br /> �� � � 7�I� ��6 <br /> Si re of OwnerlContrac od � horized Agent Date � <br /> .�--- <br />