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�ERMIT APPLICAT�Ol� <br /> CITY OF EVERETT PERMIT SERVtCES <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 <br /> SITE ADD,RE55 PARCEL TAX I,D.M PERM(T# <br /> 1401 �,Gt.�IG OpE3'�l 0000t�coloo �o�.or-oo <br /> LEGA LO7N0.� � g�p�K �q� <br /> DESC. <br /> OYYNER ADDRESS GITY2IP PHONE (�25'�, : <br /> �F tJ�a►ruoW►,� I�,P. 1940� 4���w. Sucr�, a.90 t�..,�,°�a3vi ce-w 9aya <br /> TENANt NAME CONTACT FOR PERMIT PHONE <br /> �F. P�ur�pv�,r l� P I +�.1 �i vA �tZS 3'7�8 -a-to7 <br /> CONT(tpCTOR O� �,Q� I�ICi ���� CITY2IP PHONE <br /> 201 b3 �''�-5�.b4 � � t.�2S- �181- �'t S5� <br /> CONTRUCENSEN��p� 'q�Qd 4�p��rytlfi�`1�72. <br /> � VU <br /> USE OF BUILDING I NEAT SOURCE CONTRACT PRICE OF WORK <br /> �,�J� ��4r V Electric ____Gas^Other <br /> WORK DESCRIPTION <br /> 'PU111�1.�iN�C'- N�.� �AIJSTP�t1G'10h� l�lX-TI�i11t�(l.�-� <br /> PLUMBING MECHANICAI <br /> N0. TYPE OF FlX7llRE OR ITEM NO. 7YPE OF FDfTl1RE OR 1TEM <br /> Toilet A/C—air handliny units <br /> Bathtub Forced air systems <br /> �j. Lavatory(vrash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink&disposal � Gas flreplace <br /> ,�, Dishwasher ^ Gas renge <br /> 2i'l Clothes washer Clothes dryar <br /> � Water heater R:nge hood <br /> _ Sink(service/badmop/etc.) �` Fxhaustfan <br /> Backflow preventer Heat pump <br /> ` Urina� _ Unit heater <br /> _ Dri�king Fountein _ Boiler <br /> _ Floor drain RefrigeraUon <br /> ,_ �rease irap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritity that I have read and examined this application and know the same fo be true and crorrect. All provisiona of laws and <br /> ordtneces goveming this type of work wili be compiied with whelher specified herein or not.The granting of e permit does not presume <br /> to give aulhor' to violate or caneel the provision of any olher state or loCal lew regulating construction or the performance of � <br /> conslruelio at I am au o ' ed by the owner of this property to perfortn the work for which applicatbn is mede and I tomply with the <br /> Stata Con ors�aw 1 CW and 296.200 WAC. <br /> .�=-- � ta o (m �, � <br /> ignat o er n ctor/AufhorizedAgent ate �0�� <br />