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� PCRi��IT APPLICATICyN <br /> CITY OF EVERETT PERMIT SERVICES <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 'O 4 PM �Z_p/ .-�J� <br /> SITE ADDRESS � PARCEL TAX I.D.# P RMIT# <br /> � ��-��e 5< s�a - / <br /> LEGAL LOTNU. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> t��'. �p$�7' f�u�'l�e S r'S°Z?� /�Y=S�� �rP/1� G1�ZD � <br /> TENANTNAME CONTACTFURPERMIT oHONE <br /> �-nLE �t1-S 1�-/��C7CJ. <br /> CUtiTR�oiil/� K 5��4 ///L�/�/C[l'� E /(o�� /i!�`�HT� •IZOCITY2IP P,ys2�5 3�Y-7�s7? <br /> CGNTR.LICENSE il �������� 4$'�Z 3 <br /> ��9i4-�v12_,l�Z DA <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��'�L �yl� � _Electric _Gas_Other �� �� <br /> WORK DESCRIPTION , ' <br /> n�ir�a,s o k� n,� �o kc! �'�'� P'p.�ry <br /> � i'o �S 9��2��2��5 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF�IX7URE OR!TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A!C—air handling units <br /> EalhtuL Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishws�aher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water healer _ Range hood <br /> Sink(serviceNadmop/etc.) _ Exh�ust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other _ <br /> Olher_ ./�� �I <br /> 4S /Yl�!C �(�(�4 > <br /> L�,Tz'021�5� _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � nereby ceritify that I have read and examinad this application and know the same lo be lrue and correcl. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granling of a permil does not presume <br /> to give aulhority to violate or cancel lhe provision o(any other stale or local law regulaling construclion�r the peAormance of <br /> construction.That I am authorized by lhe owner o(this property lo per(orm the work(or,vhich application is made and !comply with Ihe <br /> State Conlr ctors Law 18. 7 RCW and 296.200 WAC. <br /> �2�-o �- <br /> Signa ure of Ownar/ConlreclodAulhorized Agenl Dalu <br />