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P�RMIT APPLICATIVN <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 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCE�TAX I.D.N PERMIT N <br /> LY�01 WE TNORE a�E 004391(,1.400i0U ✓�U ' �JZ <br /> LEGA LOTNO. BIOCK TRACT <br /> DE'SC. � Z 54 S (�(o(.- DOO <br /> OIYNER ADDRESS CITYIZIP PHONE <br /> �OIT L�wRONER Qpn'TNQaS �.P 1�,0. �o[ 3Z1 MEo��.th 99a39 <br /> 7FNANT NAME CONTACT FOR PERMIT PHONE <br /> Wc1.L5 Fh¢�1u I Jvs�i.1 EvrtiNS 253- Q(11^31Uo <br /> CC�NTRACTOR E�,�-� ���eQ�•„� ADDRESS CITYZP PHONE <br /> C-.�..��a.�.�.-i.,.,y <br /> CONTR.LICENSEIt $�y WG�T NEere¢ S�. ��ENT ts3-� q3-31cx <br /> E��-rEccyt� co 9 t�3'Z- <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �3w.a�c oFFILf Eledric Gas Other � 15 Q� <br /> WORK DESCRIPTION <br /> ZEMsoB� Ek�ST�y1 �uw1FKNCE RvaGr� �wZo TWO SGPEp,��7G OCR��f grn''aS• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet f� A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boi�er <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this o(wor�;will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to viol o rancel the provision oi any other state or ioral law regulating construction or the peAormance oi <br /> conslruction.That a a orized by the owner oi thi�propeRy to periorm the work for which applicalion is made and I comply with the <br /> State C tracto L 27 RCW and 296.200 WAC. <br /> � �-.?Y-as � <br /> 'gna re of Owner Contractor/Authorized Agent Date � <br />