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PE�;MIT APPLICATIO�� <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 - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I� � o -/9 �� �� -C� <br /> LEGA LOT NO. BLOCK �tRACT <br /> DESC. <br /> OWNER ADDRESB CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT pHONE <br /> �'�.���x,'s s('a �.7 's �•�.;t� I G�aK�� 6-.�'�'�-��sJ� ao� - 6 .SL� 6o6-'�j <br /> coNrrucroa ��a r-�rdow`� 7�Yz�`G—��%2 ur t' u-6aX v76 3 �C'2 iLjE�K/� PHj,c��0 CGl <br /> CONTR.LICENSE#�l IV�P� ���' �� <br /> �� _ �//i �0�� ao�-� � �-6��� . <br /> USE OF BUILDING I — HEAT S UO RCE I CONTRACT PRICE OF WORK � <br /> �(/� d- n�5����.L,��G Electric Gas ✓ther � / � S�� Q J I <br /> WORK DESCRIPTION r n ' { <br /> �/✓dJ �1�1< ,F}� (/�- 3G1� - �/�K< dv1��l`�-$.slootf Sy34�JciJ ! n/ /�i�7C.Gr�w <br /> ��G ��� - <br /> PLUMBING MECHANICAL <br /> NO. TYFE OF FIXTURE OR ITEM NO. TYYE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airha�dlinguniLs <br /> _ Bathtub Forcedairsystems <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 /> Laundry tray Range hood <br /> I _ Sink(service/bar/mop/etc.) _ Exhaust fan ti� / ��� <br /> _ Backfow preventer = Heat pump , ��� <br /> _ Urinal Unit heater <br /> Drinking Fountain — Boiler ��} <br /> � _ Floor drain _ Refrigeration � <br /> � _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> � <br /> ! CITY Or EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> � <br /> ii hereby ceritify that I have read and examineG this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> � ro givs authonty to vielate or cancet the provision of any olher slate or local law regulatlng wnsVuction or the perfortnance of <br /> construction. That I am authorized by the owner of this property to perform the work for which applir,atlon is made and I comply with the <br /> State trectors Law 18.27 RCW and 296.200 WAC. <br /> , <br /> I , ,}�-,�o - �oa C/ <br /> I gn ure 0 ner/ ontr r uthunzed Agent Dat p <br /> I / <br />