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P���MIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org n� �D� �� <br /> �� <br /> APF'LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ApDRESS ` 1c � PARCEL TAX I.D.# P RAMIT# <br /> 5�.� � �'G '`'f� � .79� '� J' l� v 30 36 0 o I ��� ��' ��3 <br /> LEG,a LOT N0. BLOCK TRACT/,., _ <br /> oesc. 3 �'��� <br /> ON'NER ADDRESS CITYI_'.IP PHONE � <br /> I -- � �D ��t•�' G���/� G �O �� `T'/D C� , Gr�q 9F° z,1 d <br /> i�NANTNAME CONTACT R� P NE <br /> i I <br /> i _ � Z.) ` � �8 �� ? y <br /> I CONTRACTOR ADDRESS CITY2IP PF!ONE <br /> ICONTR.LAENSE# � � � � " � <br /> v w��J <br /> USE OF BUILDING I — HEP'-30G",.t,-E I CONTRACT PRICE OF WORK <br /> ��� Electric Gas Other � �� 6 � O <br /> WORK DESCRIPTION <br /> �3 �' / � � <br /> r� � � �� � /v5 <br /> PLUMBING MECHANlCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE 7R ITEM <br /> J� Toilet A/C—air handling units <br /> � Bathtub T Forced air systems <br /> �f `� Lavato wash basin �§� <br /> �;.— �Y ( ) Gas piping <br /> � �'� Shower —'�9 Watcr heater <br /> _L Kitchen sink& disposal _� Gas fireplace <br /> 1_ Dishwasher _� Gasrange <br /> � Clothes washer � Clothes dryer <br /> _ Laundry tray 1_ Range hooa <br /> _ Sink (service/bar/mop/etc.) ��,_ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> � ' I' Roofdrains Other <br /> I -'= Other = — <br /> � � <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS]105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be true and corn�;t. All provisions of laws and <br /> ordinaces governing this type of work ,vill be complieo with whether specified herein or not.The grantin;of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by lhe owr.er of this property to perform the work for which applir,ation 's made and I compty with the <br /> State Con: tors L� 1 B 27 RC and 296200 WAC. <br /> � ��O `"�� /I ��!� �/I17 �— � v�0`f <br /> Signature of OwneqCon ractor/Authonzed Agent Date �. <br /> I ` <br />