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P�RMIT APPLICATI(��V <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 A.CCIEPTED FROM 8 AM TO 4 PM - DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL Ti�:t I.D.R � PERMIT A <br /> Zsai M�w:�� �vE o05447o �sov So3 I P6e�y-�Z- <br /> LEGA LOTNO. BLOCN TRAC <br /> DFSC. �" �S �i,VF}/t�25T <br /> OWNER�V� M�DLE DBA ADDRESS CITY2IP PHONE <br /> fas7-zc Dw��'s �c . l7SZg 3 7�[l2 NE �-¢u,��-n,�v /�1S3Q4-4663 <br /> TENANT E I CONTACT FOR PERMIT W ��223 PHONE <br /> �/ �'.r QL��t/C-'2 - S�� /�i3o✓E <br /> CON ACTOR ADDRESS CITY2IP PNONE <br /> CONTR.LICENSE K <br /> USE OF BUILDING I NEAT SOURCE CONTRACT PfICE OF WORK <br /> S�2 _Electric _Gas_Otber <br /> WORK DESCRIPTION <br /> D��v t_ x;z�n��. SZ�Z <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR IiEM <br /> Toilet FUC—air hanr,;i�g units <br /> Balhtub Forced air systems <br /> Lavatory(w�sh basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cblhes washer Clothes dryer <br /> Laundry tray Ranye hood <br /> Sink(servicelbadmop/etc.) Exhausl tan <br /> BackFlow preventer Heal pump <br /> Urinai Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease Irap Woodstove <br /> Roof drzins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application a�d know the same to be true ard correct All provie`ans of laws and <br /> ordinaces governing this type of work will b�omplied wilh whelher speciTied herein or not.The granting of a pertnit dces nol presume <br /> to give aut�q dy to oioiate or cancel IheqSrovi�ion of any other state or local law regulating construction or the perfortnance�f <br /> constru�on. h I m authorized y�he owner oi this property to periorm the work for which applicatlon is made and I comply with the <br /> State��ontrac�rs La 7 and,2g6.200 WAC. <br /> � � �l�j �'�T D�j <br /> \/� ��� <br /> Signaiure o OwnedCon ractor/Au nzed Agent Date <br /> / , <br /> / <br />