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P�RMIT APPLICATI(�nl <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITF.ADDRESS �- � PARCF.L'i AX I.D.# PERMIT il <br /> ��� � IZI�InIIEIZ �� 0039 a o Q� �3 � 0/� <br /> LEGAL LOT NO. BLOCY, TRACT T� <br /> DESC. � Q B2U2Y'I ''ll S Vlv.. l 4Z$– -7DlL <br /> OWNER ADURESS CITY2IP PHO E <br /> S�TEVt L.,,4NDsv�RK d3is STIZlIW14Lit ��a� t�}I�el( wa 98orz <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE M J�.�V��L���j <br /> �� �G <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF Wqft;' <br /> St�–� Electric �Gas Other <br /> WORK DESCRIPTION <br /> /�r�J .f�J1'(�: � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i� Toilet A/C–air handling units <br /> � Bathtub Forced air systems <br /> � Lavatory (wash basin) _(c Gas piping <br /> �i Shower. Z Waterhealer <br /> � Kitchen sink&disposal �l Gas fireplace �`� <br /> 1_ Dishwasher Gas range ��r� <br /> 1_ Clothes washer L Clothes dryer ' I � ��� <br /> _ Laundry tray � Rangc hood ! 10 i�-`' <br /> _ Sink(service/badmop/etc.) � Exhaust fan ,� rd <br /> _ Backtlow prevenler 'G. Heat pump <br /> Unnal Unit heatet "'% <br /> _ Drinking Fountain Boiler � <br /> _ Floordrain �. Re(rigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX COOE�5 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 governing this type of work�vill be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authonty to violale or cancel the provision of any other stale or local law regulating construction or the performance of <br /> consWction.That I am authonzed by the owner of this property to perform the work for which application is made and I comply with the <br /> State ContracWrs Law 8.27 and 296.200 WAC. <br /> �- � �'.�� �/ ' / <br /> SignatUre'of �n ontraconAuihorizedAgent `�'`�( �L� Datens IIZi <br />