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_� <br /> �ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.orc,� ' <br /> APPLICATIONS AItE ACCEPTED FROM 8 AM TO 4 pM <br /> SITE ApORESS PARCEL TAX I,D.;9 PERMIT� <br /> 1401 l, � P.�I� OOE3'�1 OOOC��co1o0 I�`f� df� o/-oc <br /> LEGA LOTNO.� /y BLOCK TRACT <br /> DESC. "� <br /> OW F.R ADDRESS CITY2�p PF10NE (�ZS�, " <br /> �F O�.vr�m�- L� P. t9yoi y0��w. � a� t�+,auw� °�3� cdw 9aHa <br /> TENANT NAME CONTACT FOR PERMIF PHONE <br /> FF. �rw�oPr►+�' l., P. I P.y�t�1 Co�R.vA�1 '-1�ZS 3?-s -a�to� <br /> CONTRqCTOR 1�1� r.... . ,�M�� �� ApDRE59 CITY21p PHONE <br /> vr..���...�.� <br /> �ID3 l�Jt.�oO-5}{oN G-0, NE <br /> corrtte.uc�Nse,�O�-Wh�';�``Ilo Bg l�'000wa�k��°lB�tz �?•S-'-t*a t -�iSS�S <br /> USE OF BUU,pING _ I HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> I V�U VP�yw �Elactric _Gas i Other <br /> WORK DESCRIPTION� <br /> �n�.Pa�)�_ N�W CA�-e�u—�o� �v►�x-T��,�,�u.� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYpE OF FIXTURE OR ttEM <br /> � Toilot � A/C—air handling unis <br /> Bafhtub Forced air systems <br /> (0 Lavatory(wash basin) __ Gas piping <br /> Shower Water heater <br /> ,'� Ktchen sink&dlaposal � Gas fireptaee <br /> � Dishwasher Gas range <br /> Clothes washer Clothes drver <br /> ' � Waler heater Range hood <br /> _ Sink(service/baNmopletc.) T E#�aust fan <br /> ,_ Backflow preventer Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founfain Boiler <br /> Floor drain Refigerafion <br /> � GreaseUap Woodstove <br /> Roof drains Other <br /> _ Olher — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> •I hereby ceriU(y that I have read'and examined this appliwtion and know the same to ba Vue and comect. All provisions ot laws and <br /> oroinaces govaming this type of work wili be complied wlth whether spocified herefn or noL The granting of a permit does not presumC • <br /> to give a�rthori to violate or cancel the provfaion of any other state or local law regulating constructlon or the pedortnance of <br /> wnsM�ctlo at I am au ' ed by the owner of this property to peKortn the work for which application is made and I comply with the <br /> State Con ors Law 1 CW and 296.200 WAC. <br /> �� ' _ � p <br /> Signat e o er nt croNAutiiorizeC Agent �t° �' �U' � <br /> - , �o <br />