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IP <br /> r <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.# PERMIT# <br /> Sod c ot- y Av1• 00430////700/00 (Pcrtoi S) • 1 b► _c227- <br /> LEGAL}.. <br /> C; r-LEGAL LOT NO. ,�J, BLOCK TRACT OR SUBDIVISION- # <br /> DESC. -[Paz ( I 7 ii f pt,Al OE ` [ ► 1 !`'ou / f'A <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TawcktS[oNE CCIRR,Mri op 2o2-5 F IRS"f AVE,Set-f 1212- SEA-T1 V4t 2*-357-Zo5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE 2Q/ - 76:4,.. 83 00 <br /> WA JEFF KlII-UANI E-MAIL 18 ft to ®Jbit.CO <br /> CONTRACTOR -Mr) <br /> CITY/ZIP PHONE �f <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> H0151-- X Electric _Gas X Other <br /> WORK DESCRIPTION J cJ cc= A. 1,cw f11 (- 141 5011-t11 l&, 91eVE/J - -o S <br /> TcrrAL- ( Lo k3 , ca. TIE .ape.) -(krp,r 1--13 Got;JsTR 0770/ l; /✓/9 2)OP <br /> A i-tcsfeL) PEIUL- SP,4C- , AND Esu, -&FAce P,4 iN6-, auei.aDia6 /5C0 floral-- <br /> C7() N1 S, AFQX G;aro 5�. cF. A.- s8 tc , AND /LS 1�k/it,& SPACE . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> # Toilet `- A/C—air handling units <br /> Bathtub a0 Forced air systems <br /> /6$ Lavatory(wash basin) I Gas piping <br /> Shower ¢ Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> I Dishwasher J Gas range <br /> S Clothes washer 5 Clothes dryer f 5 <br /> 2. Water heater I Range hood <br /> /5 Sink(service/bar/mop/etc • Ta Exhaust fan )'�'� <br /> "` <br /> / Backflow preventerHeat pump >J <br /> 2 Urinal / Unit heater <br /> / Drinking Fountain Boiler 0 <br /> 22 Floor drain RefrigeratiK <br /> on <br /> I Grease trap Woodstove <br /> 0 Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be 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 regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contrac irs 18.27 RCW and 296.200 WAC. <br /> 1 1a WIL-L-IAM S 421110 <br /> Signa- - f to, ner/Contractor/Authorized Agent o <br /> `f-2 <br />