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P�RMIT APPLICATI <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 TO 4 PM <br /> SITE ADDRESS I�+� � E� PARCEL TAX I.D.# PERMIT S <br /> T� ��75SOCLz�0�6Cr� f/��D �� <br /> 5 '7ssrvy.��ar� I� Q(�(�a <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> WI�cFQ�T l..r�r.�'t' �E2 (E�v��'r �t2 S�F�� �565� <br /> CONj�ACT•OR ADDRES CITY2IP PNONE <br /> ��1/��b —�rRE�u7�Z�� I�G'7�8 f�� �-�.�Dnuvic.cE 4ZS-d� <br /> CONTR.LICENSE#���r` �� � �E�� /Uc+TZ Jw� <br /> r—r-- <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other �f g(�j <br /> W K DESCRIPTION <br /> 7 �D�r sc�rr�x«Ee�s � 4 c���►�-1s � �iv�c�.rr' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backtlow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap ` Woodstove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that 1 have read and examined this applicalion and know the same to be true and cortecl. All provisions of laws and <br /> ordinaces governing lhis lype of work�vill be complied with whelher 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 reguia6ng construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which application is made and I comply wi:h the <br /> State ctors Law 1827 RCW and 29 200 WAC. <br /> t�.- � 6'���oE� <br /> Signalure of �vnedContractodAuthorized Agent Date , ✓ O(1 <br /> �� c� i��b _J <br />