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PLRMIT APPLI�ATI(,�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org �_pG-�j�-�., <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> ��i0` �OC-��FCL1_l..'1-� ! J � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> l'b21 GoLP�� C�V�, (�aTt'Y �GPst�DT" <br /> �P2ov�o�-.—�c� MEDI CAL C��v��. �v�� 9�2ac� ��+z.$) 2�-4os9 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N A, sT� 1-�Ea.c-� �R (�+2s) 3�t �-0601 <br /> CONTRACTOR ADDRESS CI1Y21P PHONE <br /> CONTR.LICENSE 77 <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��S��J-� p_� �Eled�c '�Gas_Olher <br /> WORK DESCP.IPTION <br /> ��.•U C�-'�`i i O!J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> E3athtub Forced air systems <br /> Lavatory(wash basin) Gas pipin9 <br /> Shower Water heater <br /> Kitchen sink&disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/elc.) Exhausl fan <br /> Backilow prevenler Heat pump <br /> Urinal Unil heater <br /> Orinking Fountain �oiler <br /> _ Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violato or ca cel the provision of any other state or local Iaw rec�ulating construclion or the peAormance of <br /> wnstruction.Th I am authori�d by the owner of lhis property to perform the work for which application is made and I comply with lhe <br /> Slate Co Law 18.27 R W and 296.200 WAC. <br /> ��I � (y� '�j OS <br /> I Signatu e of Owner/ uthonze Agenl Dale <br />