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� �ERMIT APPLICA'� �ON <br /> CITY OF EVERETT PERMIT SERVICES � ya��5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3�30� ZCo�` S+ nnogoa--c.r�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESG. <br /> OWNER ADDRESS � CITY2IP PHONE <br /> �kdr�'a►vn� 1�1oe � �1a�1,. 3303 2��'Sfi. �i�ere.� q420 l <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l�d,►��'av�►��1. �1a51t Ad.Y��.wn� l`.; , �0�-51�. �z�3laoqSq <br /> CONTRACTOR pbn� }�� OWn�'X ADORESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ Prl r"Yl Q �- / <br /> In a m� I��I �� �1�j �Electric _Gas_Other � � <br /> r � <br /> WORK DESCRIPTION � � <br /> r�Sta�I �as ��`�►�� -b �- appl�a�7e�s . 2 r��pl � ane�� b� , <br /> rh��alle Q�- -�-,►� n� �Ca�� ��p,n�O �115�1(a�on •� b�-heE- apP�tanceS <br /> ��� cdrd,�d lL1`l-�r <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURt OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory (wash basin) �_ Gas piping "1 � " <br /> Shower Waterheater.--� � Iri6}A.�.�U �Q,I�C� <br /> Kitchen sink&disposal � Gas fireplace <br /> Dishwasher �, Gas range � " `' ,, <br /> Clothes washer Ciothes dryer —{� � /nSTU-��Cd �a-T�'4� <br /> Laundry tray _ Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backilow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeretion <br /> � Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> � CITY OF EVERETT LOCAI SALES 7AX CODE IS 3105 <br /> � I hereby ceriti(y that I have read and examined this applicatlon and know lhe same to be true and correct. AII provisions of Iaws and <br /> ordinaces governing this rype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> construction.That I am authorized by the owner of lhis property to perform the work for which applicalion is made and I comply with the <br /> I' Sta:e Contractors Law 19.27 RC'N a d 290" O WAC. <br /> :� ta���.e. >( .�-O� ��as��5 <br /> ! a ure of OwnedContractor/Authonzed Agent Da� <br />