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PERMIT APPLICATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR �TREET, 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 1.0.�1 P RMIT/ <br /> 17 � o0 03 � 2500 � �� <br /> LEGA LOT N�OI.A�. BLOCK TRAC7 <br /> DESC. ZS q �{p 3 EVCR.E.'tT DW �- PLA'C oF BLk 3y8 b-lsor <br /> OWNER ADDRESS CITY2IP PXONE <br /> �.►�,��^�- £w��n.-so•�, l7�u �ocKFFEc�2 �E ��rr' ��.5� ���•84'z <br /> TENANT NAME CONTACT FOR PERM�T yK;P ,g E 252^T7� <br /> �"`� �G��[ �MGfI.SD�/ <br /> CONTRACTOR ��E OWNER ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE k <br /> USE OF BUILDING I HEAT SJURCE I CONTR/�CT PRICE OF WORK <br /> � ���� ��i�� ,�,�� �Electric J�Gas Other <br /> WORK DESCRIPTION <br /> (�.����EL Z -�C/5?�ivb r7���C�olvlS T0 � �.�O6LC7Ow` -1 <br /> � Z �'�"�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE GF FIXNRE OR ITEM <br /> _� Toilet _ A/C—air handling units <br /> Bathtub Forcc3d air systems <br /> I � Lavatory(wash basin) _ Gas piping <br /> Showcr Waler heater <br /> Kitchen sink 8 di�posal Gas fireplace <br /> D�shwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) = Exhausl fan <br /> Backllow prevonler Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher__ _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7(COD�IS JSOS <br /> I hereby cerility that I have read and examined this application and know the samu to be true and correct A�I provisions of laevs and <br /> nrdinaces goveming lhis type of work will be complied with whether sp�cified herein or nol The granting of a pertnil does not presume <br /> to give authority 10 vioiate or cancel the provision of any other slale or local law rec�ulating construction or lhe perfortnance of <br /> constroction.That I am authorized by the owner o(lh;s property to periortn lhe wodc tor whicli application is made and I wmply with tha <br /> Slate tracto Law 18.27 RCW and 29G.200 WAC. <br /> � CJ� ! — cne <br /> S' n re OwneNContracrodAulhonzed Agenl Dale i <br /> - ----- --- (z I <br />