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P�RMIT APPLICATIV(N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98�01 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 �-al _Qg <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT�k <br /> �I�;is � ���,�� (l �e �Vl 3- u� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRFSS CITY2IP PHONE `i25 �y-�� _� � <br /> J` lJ <br /> Cc��41�e���� L � n1� Kee ��t C�>u��l ���c Gu���e}f `-18203 � <br /> TENANTNAME I CONTACTFORAERMIT PHONE <br /> V��17�� E�dAIL <br /> �� 5 � <br /> CONTR.LICENSE It <br /> USE OF BUILDING — HEA1 SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> C�C,��vc'ri � C� ,�c,S <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilcl A/C–air handling units <br /> _ BalhWb � Forced air systems <br /> _ Lavalory(wash basin) Gas piping <br /> _ Shower � Water heater <br /> = Kitchen sink&disFwsal � Gas fireplace.� <br /> Dishwasher Gasrange <br /> _ Clothes washer � Clolhes dryer <br /> _ Waler heater Ranye hood <br /> Sink(serviceNadmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> _ �loor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains � O�her � ` � �,<- ;' " v�'!�1,0( <br /> Olher !�� ' <br /> — — ,� �'� h�� �lu�v+l ' � Gv�G� �c� 5�"U."�Z.. <br /> li ^' i� �J_�,L � <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS�105� <br /> I hereb�cerilify thal I have read and examined Ihis application and know the same lo be We and correcL All provisions of Iaws and <br /> ordinaces governi:ic�ihis lype ol work will be complied wilh whether specitied herein or noL Tho granling of a permit does not presume <br /> to�ive au�honty to violale or cancel the provision o(any olher state or local law regulating conslruction or the performance of <br /> conslruclion.That I am authorized by lhe owner o(lhis property�o peAorm ihe work(or which application is made and I comply with the <br /> Stalc Contraclors Law 1827 RCW and 29G.200 WAC. <br /> � � <br /> �--i��'�n �� �, �11���cv� �-'i l�lcz,c:�, �i �2CX� <br /> Si�thr�o D edConl ador/Aulhonzed Ac�ent Dale <br />