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( <br /> PERMIT APPLICATION <br /> CI'TY 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 6 AM TO 4 PM /O " �7 �-/d <br /> SITE ADDRESS PARCEL TAX I.D.N PE MIT X32 <br /> �OZ �+.a <br /> LEGA LOT NO. BLOCK CTPACT OR SUBDIVISION R <br /> DESC. �. Z � L <br /> OWNER ADDRESS CITYIZIP PHONE <br /> G �1� ♦� �R-�Ti' 3101 GfcpaR�� � � <br /> TENANT NAME CONTA�T FOR PERMIT PFiONE ��.`�, / <br /> `�., -'�` � I � N�(,� EJAAI <br /> r�UVK1i� <br /> IJ�,pa,10 CerKT. 34a7 G �'�' s1'• �Y��'iT�4b?o1�7` <br /> CONTR.LICENSE N I�' y 't�.q�� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'iD�I(iIr�ON�` _Eleclric _Gas_Other Q�.� <br /> {���/ . • <br /> �'RT��SCR��N��.SMM��/11T � K�{ � �T <br /> i!'�f' ' �y��u,*N����c��hY.1i+s/OKS � i/.�Cl. �e�t <br /> 'p D�IuI�e.�P <br /> P UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> � '— Forced air systems <br /> ` Bavatory(wash basin) Gas piping <br /> � Water healer <br /> y Shower Gas fireplace <br /> Kitchen sink&disposal '— Gas range <br /> �Aishwasher = Cblhes dryer <br /> Clothes washer Range hood <br /> Water heater Exheust han <br /> � Sink�cervice/bar/mop/etc.) Heat puihp��., <br /> _ BacktioW:preventer ilnit heatef� � <br /> Urinai ��, — Boi!er � <br /> � Drinking Fountain Refrigeratio\,�'., <br /> � Floor drain � Woodstove � <br /> Grease trap � :�� Other \ �. <br /> _ Roof drains �'` — � � <br /> O�her — � \ <br /> — ---� — <br /> �'� CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby Ai ihat I have read and examined this appiication and know the same to be lrue and cortect. AI�pro•aisions of taws and <br /> nan s go rning this type o(work will be complied with whether specified herein or not.The granling oi a permit does not presume <br /> o ve thoril to vi ate or canc�l the provision of any other state or lor.al law regulaling construction or the periortnance o( <br /> on ru tion.T at I aulhorized by the owner of ihis property to perfor the work for which application is made and I comply with lhe <br /> a ntract r L 8. RCW and 296.200 WAC. �� 10 <br /> i r of wn a thorized Agenl ate ��� <br />