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a <br /> �ERMIT APPLICATlON <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 <br /> SRE ADDRESS PARCEL TA?C I.D.N PERMIT fl <br /> NOI l. � OOE3�"l OObC(,(olOC7 I�GGI -LL^i� <br /> I.HGA LOTNO.� � BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2tP PMON <br /> �F, CJ�i1r�oW►�t�ur' 1-�� 19�101 �10�� W. Suc�, � 1.��►�,o �So3V '�2S- � <br /> TENANT NAME ��'9aya <br /> CONTACT FOR PERMI7 PHONE <br /> F�. ����- U P. ��J Coi�vA� '.i�zS 371d -a-ta� <br /> CONIRACTOR/'1� ��,_y, . Q� ",���b �� ppDRESS CT'21P PHONE <br /> VN�Wq��� l wr <br /> CONTR.I.ICfiNSE�1 �d3 W�D`�� �� �'1'LS-�lavl -�STS <br /> OIue�AP� Iqlo.� W���� q$�nz� <br /> USE OF BUII.DING I HfAT SOURCE CONTRACT PRICE OF WORK <br /> 1�'w�^ 1��'VIM�� v Electrlc _Gas_Other I <br /> WORK DESCWPTION <br /> '1 Wl'�,Q��1f/- N�.1� �ANSf'iLUGt'lOh� 11�L1�-TI�A?N�IU.-� <br /> PLUMBING MECHANICAL <br /> N0, TYPE OF FIXTURE OR REM NO. 7YpE OF FIXTURE OR ITEM <br /> Toilet A/C—alr handiing units <br /> BathNb _ Forced air systems <br /> '� lavarory(wash basln) Gas piping <br /> Shower Wator heater <br /> � Kitch?n sink&disposal i Gas fireplace <br /> ,(�� Dishwasher Gas ren e <br /> 1� Cbthes washer Clolhes dryer <br /> lo Water heatBr � Ran e haod <br /> ,,_ Sink(servicelbadmopletc.) � F�austfan <br /> Backflow preventer Heat pump <br /> ` Urinai Unit heater <br /> Drinking Fountain Boller <br /> 4 Floordrain � Ref�igeration <br /> Grease trap Wootlstove <br /> ,_ Roof drains � Other <br /> oMer — <br /> CT'OF EVERETT LOCAI,SALES TAX CODE IS 3105 <br /> I hereby ceHtlfy that I have read and examined this application and know the same to be true and conect, All provis�ons of laws and <br /> ordinaces govemfng this type of work wlil be eamplied with whelher specified hereln or not.11�e graMing of a perrnk does not presume <br /> 10 glve authori to violate or cancel the provislon of any other state or local lew regulafing conshuetion or the perfortnance of <br /> eonstructio at I am a io ed by the owner of this property to perform the work for which application Is made and I wmply with the <br /> Stafe Con rs Law 1 RCW and 296.200 WAC, <br /> Y�...=----- l (p 0 (P \, D�p� <br /> Signa e o er on ctorlAuthorized gent ate �� <br /> . `nQ <br /> r✓ <br />