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, <br /> l <br /> �- PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TA%I.D.K COV3 103—�`�� PERM�T N <br /> I�l�-1" �l}�lrnC t � ) �� -CX. <br /> LEGAL LOTNO. BLOCK TRACT <br /> oeso. .� _ 3-� + <br /> OWNER AUDRESS CITYRIP PMONE 4�S <br /> �,b �m�rew!_ -Z�;�� tav,. �,u� `Ae-� � o � l�� -`�- .h <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 1� �.�2, �� � ,��,au) �31�38 I�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> l.�hn-�j� ���t��'�h'onl,lC. �.o. t'�(, `�t�i �'.�i, u,�14�•5�9�I aS3le3�t- I�1X <br /> CONTR.LICENSE� ��������C�U�O�C �y�� �"al-vS � <br /> ""'1�' 'j'L'� `�.� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT RICE OF WORK <br /> ���, _Eledric _Gas_Other '1 �OS. 00 <br /> WORKDESCRIPTIONT(�j-.Q,,�'Itr�(NUIIQr,v'v�q. _ I�Idt�, (.'�{1�Q, I�Qjc� A„�r.� u�,�y�io•.CJG?'•-�� 0.G�G(�`Y-nK. ��C(, <br /> �.1�� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet AIC—air handling unifs <br /> 8athtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firepiace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hoad <br /> � Sink(service/bar/mop/etc.) Ezhaust fan <br /> Backtlow preventer Heat pump <br /> UrLial Und heater <br /> DnnY.ing Fuuntain Boiler <br /> _ Floor drain Refngeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE I51105 <br /> I hereby ceritify thal I have read and ezamined this application and know lhe same to be true and correct. All provisions of�aws and <br /> ordinaces goveming this type of work vnll be complied with whelher spedfied herein or not.The grenting of a permit dces�.:oresume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the pedortnancr rv <br /> construdion.That I am aulhorized by the o er of Ihis pmperty to periortn ihe work for which application is made and 1� ��r�r with the <br /> State oniradors Law 1827 RC, . n . 00 WAC. <br /> �^ � r ��' �/ <br /> SignaWre of Owner/Conhador/Authonzed Agent Dale Z <br /> I <br />