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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVcRETT, WA 98201 <br /> `��n`, Ln���� ��A25-237-8810- FAX 425-257-8857-www.everettwa.org � �a S'�� <br /> � CC.J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PEFjMIT# �S <br /> X x Me � 11 Cr�ck kw ozzSo4- 3- ooi - 000s ,i �`/z - - <br /> LEGAL LOTNO. BLOCK , _T�T� 1an r�o , 89 i o 2550 � o <br /> DESC. y Q1 t'1d� yj. � <br /> OWNER A��RESS CITY121P PHONE 'L06 728 <br /> Inlra�o�-p �e�,l E5�'o� 2505 - 2�,,d �fc Sea-I-}lz `�g,tZ� 456 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> Ic Censi�'vcju+�, zso s - 2..d Av<. Sea� t,� 9�.� �-� �.o� 128 4�C6 u <br /> CONTR.LICENSE• I <br /> ; - 1�- �7 <br /> USE OF BUILDING • HEAT SOURCE � CONTRACT PRICE OF WORK <br /> $ GCU �a�I Ve , 2 <br /> m��v [_ �i.,ur'n� _Electric Gas_Other :li �dd 1 � � � <br /> 'f� <br /> WORK�ESCRIPTION • <br /> New }, 1-1-�� cor� < r�}�� rr� an., �.�}vf, rv� b 1c3�. `1 S, �1-a0 5 � <br /> -Fook�s�n �- a•-,d 31 �-� �� � � h ¢�b��- J <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitche�sink 8 disposal _ Gas freplace <br /> Dishwasher Gas range <br /> Cblhes washer C�athes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refriqerat�on <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> I hereby ceritify that I liave read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whelher specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regwating consiruction or ihe perfortnance of <br /> construction.That I an ut n�ed by ihe ner of�his prop=rty to perform the work for which application is made and I wmply with the <br /> Stat�ont actor5 La . 7 fj W and .200 WAC. <br /> / � � �� yg o5 <br /> I ignaWre of OwnedCont cror/Authon ed Agent Date �/ <br /> i � <br /> `-- — — — - - <br />