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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org G `� —/O <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM rl'� � �� _ (�2 <br /> SITE ADDRESS PARCEL T,4X I.D.N PERMITN <br /> `-J��l �r� ��^ W, 2 $vyv.� �2 0 �o� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION 8 <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> 5e�wa�S CD�Ortti�e �t 3C y 93� ,v� y�t� st ,$e.��e c/fr I/5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE 2�_�� �- 3 i 3 � <br /> ,�(.l!'R.� �(eTrU �.� U�oo�tS E-MNL MF-�fI E7�2✓c��er�ti vac.c<in <br /> �VC/��e2n �e-�i'��rw-F�on- <br /> CONTR.LICENSE# rVLI�C 12L-GIS�'IR2 ! 2 � s. k��^-`Jo,� .S"�" .�c, ��G� 98/O$ 9-�-'�63-�7yy <br /> C v <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric S�Gas Other � 8�� <br /> . <br /> WORK DESCRIPTION /+ <br /> �i'�S-fn,i�� O/IC. �I) infalc� Y�oo� a.nr.Q 2t�'�-fa/� tx�••"'s'�" �-r-n -fo�' $C��•�« �ai'...y.c_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> _ Water heater Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> BeckOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> _ Grease vap Woodstove <br /> Roof drains ! Other 200� {ioo� <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby certify that i have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type o(work will be complied with whether specified herein or not.The grenting o(a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulaling construction or the performance of <br /> construction.That I am authorized by tha owner ot this property lo peAorm the work for which application is made and I comply with the <br /> State Cont act rs Law 1827 RCW and 296.200 WAC. <br /> ,��.��� �« �«� <br /> Sl�gnaWre o`OwnedContrectodAulhorized Agent Date <br /> I�Z <br />