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PtRMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4.'S-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S -c�7 --Q / <br /> SITE ADDRESS �E`fe�N + �`�3 pARCEL TAX I.D.N PERMII'• <br /> 1 �513 S�1�e; �ake DY � �5:7 S cx)� <br /> LEGA LOT NO. BLOCN TRACT ORr SUBDIVISION K <br /> DESC. 11 \pi 01 si� i" C.. 1'Jfi <br /> OWNER ADDRESS CITY2IP PNONE <br /> \ 'P12 � <br /> 1aV� rLlf�C� ��f V� 13 r PHONE <br /> TENANTNAME CONTACTfORPERMIT <br /> s C-,�� t��a�-yti�� <br /> — 5eba tiav� <br /> e�a��lrs;nnseba5li�n�• om <br /> -�66k�8 � <br /> �nc1�.r�h���1a,m�,��.C, �,�. �sox ��O S}nnwood �µa5)abv -9�lll <br /> CONTR.LICENS « �aa a <br /> CNUuk'�{ L�Fflf�3 — — — I <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eiectric X Gas Other ��I U �U� V • �-�u <br /> SFR <br /> WORK DESCRIPTION <br /> SFtZ Al�tl��-t� � Iv92 s��f+ <br /> PLUML'ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM — <br /> _J_ Toilet A/C–air hanAling unils <br /> _�___ Ba1hWb I Forced air systems <br /> Z Lavalory(wash basin) � Gas piping <br /> I Shower Water healer <br /> Kitchen sink&disposal � Gas fireplace <br /> Dishwasher Gasrange <br /> _f Clothes washer � Clolhes dryer <br /> Waler healer Range hood <br /> Sink(servicelbarlmop/elc.) � Ezhausl fan � <br /> 6ackflow prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Founlain . _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Other — <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceriti(y Ihat I have read and examined lhis appiication and know the same to be We and correct. All provisions of laws and <br /> ordinaces guverning Ihis type o�work will be complied with whether speci6ed herein or not.The granling of a permil does nol presume <br /> to give aulhority to violale or cancel lhe provision of any othcr slale or Iocal law regulalinq construction or the performance of <br /> construclion.Thal I am au�horized by the owner o(this property to perform lhe work for which application is made and I comply wilh the <br /> Slale Gon aclors 'aw,18.27 R and 296200 WAC. L i/2 rG�� <br /> �� 5�7��,�,, , � �; ; <br /> Signa�ure of OwnedContreclodAulhorized Agent Dale � / <br /> �Z <br />