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�EI�MIT APPLICATIUN <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 /> / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P� 07 -3 C7 <br /> SITE ADDRESS �JJI PARCEL TAX I.D.# PERMIT# <br /> 33(9 �tl1LAL1P AVE EVC-1�TT, WA 005839-�83 -�IZ -�Z ' �7:� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION 11 <br /> DESC. ��S �z� �3 �g3 STAN�oK�O 1�1�D C� • �DD I 0 �VE��T'1- <br /> OWNER AUDRESS CITYIZIP PHONE <br /> GE.LEOONIG \IELE.Z 33iG 'TULII�IP AV£ EV�.42�TTrWA Z�6"3�35 23�5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> !E LkDON I 0 �lLt-LZ- <br /> E-MAIL <br /> �.`bFYfA A S I I <br /> CELEI�ONlO V�LL:'Z- <br /> CONTR.LICENSEM O� /_/J/_ l <br /> <J C!"7(J� <br /> USE OF BUILDING HI•AT SOURCE CONTRACT PRICE OF WORK <br /> J''�f� ✓ EIeW:ic �Gas_Olher ��'��%� <br /> J/�— — <br /> WORK DESCRIPTION <br /> �,Sf S.F. �1Dll NEW zNn F�oC,��+ IdEW Eh�n�� � M�Noc� A�'ft�AT1oN5 �ro <br /> ���C �L. + W►�ad ADD NEw A'1'fIC �TiT HO�� A�D N�.W �OOF..E- �IE.W <br /> 5 G�/�;[,. �kjtiklC;Q S1��INC� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IT:M <br /> Toilet A/C-air handlinc�units <br /> � Bathlub _ Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> � Shower Waler healer ?�j � <br /> __ Kilchen sink&disposal � Gas fireplace � y <br /> Dishwasher � _ Gas range /� <br /> _ Clothes washer — Clothes dryer ��2 <br /> Water healer Rango hood `J <br /> Sink(service/bar/mup/elc.) Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinl;ing Founlain Boiler <br /> Floor drain Refri�eralion <br /> _ Grease trap _ Woodstove <br /> Rool drains Other E�-t�.• H�=+�ir <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceriti(y ihat I have raad and examined lhis applicaticn and know the same to be true aad conect. All provisions of laws and <br /> ordinaces goveminc�this lype o(work will be complied with whether specified herein or nol.The granting of a permd does not presume <br /> lo give authorily lo violale or cancel the provision of any other state or local law regulating consWction or the peAormance of <br /> conslruction.That I am authorized by lhe owner of this property to pe�form the work(or which application is made and 1 cc mply wilh lhe <br /> Slale ConVaclors Law 18.27 RCW and 296.200 WAC. <br /> � O� OZ ZQpe <br /> Signature of Owner, r ctor/Aulhonzed Agenl Dale �(�i <br />