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PE�.MIT APPLICATI01. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> AP�'LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S "" ��I� <br /> SITE A��DRESS PARCEL TAX I.D.# I PERMIT 1� <br /> �C:( i7 Z 3 � �-DLo ��� '�'Fl��'f-� <br /> LEGAL LCT NO. BLOCK TRACT OR SUBDIVISION 8 �f� c nO� <br /> DESC. J-'� <br /> OWNER ADDRESS CITY2IP PHONE <br /> seAway r o2aor�s+-T� '-l937 NE q7�`� s, <br /> TENANT NAME I CONTACT FOR PERMIT PHON.E 17 6 G (�(�� ZQ�J � <br /> W f*< N- i 1J LT Uti. A�v i v ,y�, n S w� PV GL27f'r E-MAIL <br /> �s E�— <br /> � ea mm�ti + ry �L �n-�13r�v� �o F 14G7 S7�i9wtvvum G�r4 36a (,6/ �-vo � <br /> CONTR.LICENSE M � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eledric __Cas Olhe: p <br /> A � AOvem�✓. i � -- __ — � , � U � <br /> WORK DESCRIPTIO <br /> PLUMBING MECHANICAL <br /> NU. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—airhaiidlingunits <br /> Bathtub Forced air systems <br /> _� Lava�ory(wash basin) Gas piping <br /> Shower Water heater <br /> I Kitchen sink 8 disposal Gas fireplece <br /> � Dishwasher Gas range <br /> C� dhes washer Clothes dr,er <br /> Wa�er heater Range hood <br /> Sink(service/bar/mop/etc.) ^ Exhaust fan <br /> C�ackFlow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ! hereby certify that! have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> , ordinances governing ihis type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br /> to giv�authorily lo vi or cancel lhe pro��ision of any other state or local law regulating construction or the periormance of <br /> constnir,tion.That I m a thorized by!he owner of this property to perform the work for which application is made and 1 c�mply with lhe <br /> Stale C tra aw .27�RC and 296.200 WAC. <br /> ` J— �- io <br /> Signa re of Owne ontraclodAuthorized Agent Date <br />