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PcRMIT APPLICATIUN <br /> CITY OF EV�RETT 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 /> PARCEL TAX I.D.# PERMIT# <br /> SITE ADDRESS �-�L <br /> �(�.0 n l�(}-.�'Le �C/ � J8 <br /> IEGNL LOT NO. BLOCK TRACT OR SUE�.'IVISION M <br /> DESC. CITY2IP PHONE aC�-z�'5�3�1.,� <br /> OWNER ADDRE55 <br /> /l�a �nu ��u��� ✓el �U � G �cG��.�e��er /�ve Ev��e4'¢ �'(42v! <br /> TENANTNAME <br /> I CONTACT FOR PERMIT PHONE <br /> E-MPJL <br /> ON R OR <br /> AD RE � P <br /> CONTR.UCENSE M �W��� <br /> USE OF BUILDING <br /> — HEAT SOURCE i CONTRACT PRICE OF WORK <br /> Electric _Gas_Olher <br /> WORKDESCRIPTION �e��`f1�y �n�Qy` � �'��t{ �JO�L �^ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. � TYPE OF FIXTURE OR ITEM <br /> A/C-air handling units <br /> Toilel Forced air systems <br /> Balhlub Gas piping <br /> Lavr'ory(wash basin) — Water heater <br /> Shower Gas(ireplace <br /> Kitchen sink&disposal Gas range <br /> Dishwasher Clolhes dryer <br /> Clolhes washcr Range hood <br /> _ Waler healer Exhausl tan <br /> Sink(servicelbadmopletc.) — Heal pump <br /> �ack(lo.v preventer Unil heater <br /> Urinal — Boiler <br /> Drinking Fountain Retrigeration <br /> Floor drain — Woodstove <br /> Grease trap Cther <br /> Roo(drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES T/U(CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis applicalion and know lhe same to be true and correcL All provisions oi laws and <br /> ordinaces governing lhis type o(work will be complied with whether specified herein or noL The granling oi a permit does nol presume <br /> to give aulhoriry lo violale or cancel lhe provision of any olher slate or local law regulaling consWction or the pedormance oi <br /> conslruclion.Thal I am aulhorized by the owrer ol this property to pertorm lhe work for which application is made and I comply wilh ihe <br /> State Conlraclors Law 18.2 RCW �nd 296.200 WAC. <br /> �,�,� .�.,� �'�a��°9 <br /> Signature of OwnedContractor/Authonze Agent <br /> Dale <br />