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--1 <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 <br /> SITE ADDRESS PARCEL TAX I.D.it PERMR N <br /> / � D 7 (I E 0. ..S Z � O 0 Z � 'C�I '� <br /> LEGA LOT NO. BLOCK TAACT OR SUBDIVISION X <br /> oesc. � ZS�' Cc�,z''ff !�i✓ / l�i�� <br /> OWNE/R � ADDRESS CITY2IP PHONE �� .- <br /> C'!'4 ��G '�'' �-1 !30 7 /ri14 �� SI�' L=v�.r'I7� 1�� �$3�7� <br /> TENANTNAME I COHTACTFOR RMR PHONE <br /> �� /� /_ E#IAIL <br /> ( /'��'!�K"S �ov7�9✓L'�Ysw.,. (�b/� <br /> / � /9Yry�L 5L 9Ls- �S3 - Zas� <br /> COHiR.110ENSE 71 �IG I IS I�I�04� ,NI T C r <br /> Sn��,�..,,sti iF�ziL <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5�� x Electric Gas_Othcr � p� QU C7 <br /> 1 <br /> WORK DESCRIPiION . /� � <br /> �'Zo��cv r S �G ki ft�.+h d �/°'/�f S�Jeel4�S �e��r /�—j� <br /> /`�%Ut'S� /Ylt'.0 /��� tv/ �ui�//�'f %/!.�'�'ETO✓' <br /> / <br /> PLUMBiNG MECHANICAL <br /> NO. 7YPE OF FlXTURE OR ITEM NO. TYPE OF flXiURE OR REIA <br /> Toilet AIC—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposai _ Gas firep!aco <br /> Dishwasher Gasrange <br /> � Clothes washer � Clothes dryer <br /> _ Walen c�a�er � Range hood <br /> Sink(service/bar/mop�etc.) � Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigcration <br /> Greasc trap Woodstovc <br /> Rool drains Othcr <br /> Other <br /> CITV OF EVERETT LOCILL SALES TA7(CODE IS 3105 <br /> I hereby cerilily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces c�ovemirg�his type of work will ba complied with 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 iegulating construction or the peAormance of <br /> construction.Thal I am authorized by tho owner of this property to pertortn the work for which application is made and I comply with ihe <br /> Slate Contractors Law 1827 RCW and 296200 WAC. <br /> -�%�+ <br /> /r.�..�« �l�l� io/�,�� , <br /> Signature of Owned ontractod uthonzed Agent � �� Date <br />