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r-- <br /> p�Ml� APPLICATIU�i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-885)-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.# ERMIT <br /> I I �I I � Ia�'^ AJe S� �:lol p �-�.� <br /> LEGA LOTNO. BLOCK TRACT � i <br /> DESC. <br /> OWNER AODRES� CITY2IP PHONE <br /> D u.;�F�d;�. f�e�el opw�ev�� P,�, Box I o5�1 <br /> 5n�hor.,r�,,,�.1A °�aza� W25)-3a4 -So�g <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �Er,5a5;v�5 m;AdS I sG.�ara alder', cup�l-a� ��,1n�EU.�S <�IzS� - *��7 -`bo�� <br /> CONTRACTOR A�ORESS CITY2IP PHONE <br /> PvSe� Wesb Go�^p. P,o,f3o1( 3535 R��;,,5},N�WA �a2�3 �HzS� ' �50-�(d'jl� <br /> CONTR.LICENSE# Pv���G I,�7 k9 <br /> USE OF BUILDING ( — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> IElectric Gas Other ?�� �pp <br /> WORK DESCRIPTION <br /> Ter,an�- �tM�foJeinn2J��' <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTJRE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wash basin) Gas i in <br /> Shower — P P 9 <br /> — Water heater <br /> _ Kitchen sink 8 disposal Gas fireolace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Ciothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow 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 /> I <br /> I CITY OF EVERETT LOCAI SALES SAX CODE IS 3'105 <br /> I hereby ceritify that I have read and examined this application and know tha same to be true and correct. All provisians of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> � to give authonty to violate or cancel the provision of any other state or local law regulatlng construction or the performance of <br /> � construction.That I am authorized by the owner of this propeRy to perform the work for which applicatlon is made and I comply with the <br /> I State Cantractors Law 18.27 RCW and 96200 WAC. <br /> � �, <br /> ISign t[ne of OwnedContrac A orized Agent ate �/2, <br /> i <br />