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<br />€�.µ P�l�MIT APPLIC//�1'ION � � �����
<br />�° _ CITY OF EVERETT PERMIT SERVICES �� '��"�"
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<br /> y; ; 3200 CEDAR STREET, EVERETT, WA 98201 �'aw'�9'
<br /> � ' 425-257-8810— FAX 425-257-8857—www.everettwa.org � '^'��'�
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<br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED �+p�����'"`"
<br /> SITE ADDRESS ���"� .:
<br />����,�,� 3(� �7� PARCEL TAX I.D.# ERMIT# ra� '�
<br /> St s r _ '��t�[ �* >'�:�
<br /> o L �� ' D/CG � , ,.
<br /> � � ��
<br /> . ''I LEGAL LOT NO. BLOCK TRACT i ��.�u, `
<br /> DESC.
<br /> OWNER � 3 � �"
<br />��� ADDRESS CITY2IP PHONE Q E� . ��'���.
<br /> � , PI�uL c�+ uRcN- 3i� �fz�sr• s�. �rr �ya;4�3 Yzr-zsY-7z,s�s �� ��.� +�I
<br /> TENANT NAME � �'t'.. �`5j
<br /> ���1 CONiACT FOR PERMIT PHONE i " '
<br />�`: , '� I URV1A P�Drf2S�1.( � ,�
<br /> � CONTRACTOR 4 xt���fi°�,.�.�
<br /> a.. , ,, �u� (�,�-t�L ADDRESS CITY2IP PHONE ' 'u.�. .
<br />�* �y ��)C �7A4� �`�-�1�. �/�rlQ" �I'920(o ZS1'7ZSti i 4 °r„ ;4
<br /> �,�:, i CONTR.LICENSE# Qu�1�� q�SG7 li tip k�,3�� �
<br />���� � �'��t 3 1 �q
<br /> USE OF BUILDING � � r q
<br /> �;Ri�; � HEAT SOURCE CONTRACT PRICE OF WORK � t � �:s ;�';�
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<br /> ��i� � $Y�N�iF ROCL{rV t � ,� `4 j"�
<br /> � �.� _ _Electric _Gas_Other ,ZOrO�— , + `�� 4 S
<br /> WORK DESCRIPTION i ` ,`• ;:�_�
<br />�" `� i GOMtTR��'(.o1J dF- l� �'� �X �O' WOdp ' ` `
<br /> �M� v�� vvitt.� 13z-w�.� , � d ,,
<br />�,=f:,�+ I R"C''^' Tc� A1�1�!l�7T� Nou_c�._ ,;,�.-+�'a.t::ti.'�,?
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<br /> � s�: � PLUMBING MECHANICAL
<br />"� � � NO. TYPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM
<br /> j Toilet
<br />�' Bathfub — aC-airhandlingunits
<br /> ' Forced air s slems
<br /> 1 �i Lavatory (wash basin) — Y ,�.
<br />�' � Shower Gas piping ` �,��, �,,;
<br />`�� . � _ Kitchen sink&disposal — Water heater � ��� � �
<br /> Dishwasher Gas fireplace * � .,,�,� � „
<br />� �! I — Clothes washer _ Gas range �,* �:�x�yy
<br />' � "`��;�� ; � — _ Clothes dryer `�+ �
<br /> Laundry tray � v„___* v u>:.
<br />" T:�q ' _ Sink (service/badmop/etc.) _ Range hood I �.„, �, �#,
<br /> BackFlowpreventer Heatuuman � � ,a,i-�"�
<br /> � Urinal — � P
<br /> ' — Unitheater � t;s�� �"c'�'��
<br /> � �I � _ Drnking Founlain — , '�; tQ,
<br /> � Floordrain Boiler , ,
<br /> ' �➢J — Refrigeralion "�.°�'"t.
<br /> � i _ Grease hap Woodstove � , 'Sr �"`"°�
<br /> = Otherdrains = Other � t�u�
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<br /> _ � �'���
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<br /> II CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105
<br /> I hereby ceriti(y that I have read and examined this application and know the same to be lrue and correct All provisions of la�.vs and
<br /> Iordinaces goveming this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume 5 ,�x%:*%�"
<br /> to give authonty to violate or cancel the provision of any other state or local law regulating consWction or lhe perFormance of
<br /> construction.That I am wthorized by the owner of this property to perform the work for which application is made and I comply•,vith the r:
<br /> Sta �trectors Law 18.27 RCW and 296.200 WAC. 4, N
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