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F�tRMIT APPLICATIC,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org n <br /> I'I,J 503 '�3/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDI; :ARDS ARE NOT ACCEPTED <br /> SITE ADDRESS 3� PARCEL TAX I.D.# - "PERMIT# <br /> 1 �� 7 ZHINIEIZ I�� oo3�i o o Q� l � `=, �0/D <br /> LEGAL LOT NO. BLOCK TRACT � <br /> DES0. � (j � �I;zueri I-I; S DiJ: I 4zi --� -" 2 <br /> OWNER ADDRESS CITYIZIP PHO E ' I <br /> S�Evt LAn1Dsv�lZk d31 S S�T1211L414L1t '��aD t�f��el� wA i80iL <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> COt�TR.LICENSE# <br /> �-f C V�St��I 5 S-K/� <br /> USE OF B'JILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> SFrZ Electric �Gas Other <br /> WORK DESCRIPTION �n b� /,D�� / <br /> i� 'r 7 <br /> /��.� L)U �� e� � �VL o�- o�a <br /> `�'l(= � ��� <br /> PLU�dBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEhi N0. I TYPE OF FIXTI.RE C2 STL'M <br /> �– Toilet rVC–air handling units <br /> �, Balhtub _ Forced air systems <br /> �_ Lavatory (wash basin) _[a Gas piping �C�-� <br /> � K lchen sink 8 dis osal _'L Water heater �y L ���ti�U2/ <br /> � p _Z Gas fireplace <br /> _Z Dishwasher Gasrange <br /> � Clothes�vasher � Clothes dryer <br /> Laundry tray � � Range hocd <br /> _ Sink(servicelbar/mop/etc.) � Exhaust fan <br /> _ BackOow preventer Heal pump <br /> Unnal v Unit heater r� <br /> Drinking Fountain Boiler <br /> Floor drain Refn�eralion <br /> Grease irap Woodstove <br /> Roof drains Olher <br /> I = Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ' I hereby ceritify that I have read and examined tiiis application and kno�v the same to 6e true and correct All provisions oi L=w�and <br /> ordinaces qoverning thi� rype of work will be comulied with whether specified herein or noL The granting of a permit does nat presume <br /> to give authority to viol:.te or cancel Ihe provision of any other stale or local law regulating conswction or the performanca c f <br /> construction. Thay' am autholized 'u the o.vner of this property to oerform the work for which application is made and I comply with the <br /> State Contractor Law 7�27 C�N -nd 296.200 WAC. <br /> � i � _ <br /> � . �� L�> <br /> � Signature�Of 4 r on!ractonAuthor�zedAgent Date �IL <br />