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. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810- fAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AUDRESS PARCEL TAX I.D.X P MITM <br /> �l3 ,SEAJIE�, ��A`1 uo•`�c,��9 00300 � v3 ('r' , � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �10� ' k ��. <br /> A;�o2c�J � f� '1�--;� `t-o���� �,o� 3 S�,,Ji� �1n� cJ��r � � ��{v <br /> TENANT NAME CONTACT FOR PERMIT PHUNE <br /> �p�,�� � �a . ��� .��vv <br /> � ' ` �d� E�AAIL KAR£rlA,Ji.VT07D A �I� i <br /> I o <br /> i�J�7 ��C.I�S � �-1lLS `' I ��1��1 " oM <br /> CONTR.LICEVSEp �� / .� � S�S ,�yT� /\JE NC WA `�(�5 . ���. SSG� <br /> i�i���P1� (` i3`�I� 3 (`fk�fil� �- �- i5& 94a� 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> �l�\�� �^^'��� ����.Y.� _Elnctric _Gas_Other �/�jt+��(� <br /> WORK DESCRIPTION <br /> �.�i u� pL�K "N' i I,�,"r�('t <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel , A/C—air handling unils <br /> Balhlub Forced air systems <br /> Lavaiory(wash basin) _ Gas piping <br /> ! Showar _ Waler heater <br /> Ki�chen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Watcr healer Range hood <br /> Sink(scrvicelbar/mop/elc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Pounlain Boiler <br /> Floor drain Reingeration <br /> Grease Irap Woodslove <br /> Rool drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 hereby ceritity lhat I have read and examined this appP.,;alion and know lhe::ame lo be true and correcL A�I provisions of laws and <br /> ordinaces yoveming lhis lype of work will be complied wilh whelher speci(ied herein or noL The granting of a permit does not presume <br /> to give authoril�to violale or cancel lhe provision of any olher state or local law regulaling conslruction or Ihe pedormance of <br /> conslruction. Thal I am aulhonzed by ihe owner ot this property to pertorm the work for which application is made and I comp�y wilh the <br /> Stale Conlrar.loySL�iw 18.27 I?CW and 296200 WAC. <br /> r � �r . (1 � <br /> � i �f <br /> Signature f" , '���Contrac�odAuthorized Agenl Date �/ <br /> _.� Z <br />