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PL,ZMIT APPLICATIG�J <br /> i 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 I PARCEL TAX I.D.# PERMIT# <br /> 0057 � � l �C G�{�G-G� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> m�R � F�' S'r�Aliv TwucSrmcs,r �. Po l��Sr Ir�c, snori srra�r� �tz�" 'Zey -�ni£r <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> 14rne�r, cceh G�� � �vaSMo�� J�,,, f�(/�hs uZs �7�g �t >o7 <br /> CONTRACTOR A�DRESS CITY2IP PHONE i <br /> No,e7r( cucst- Pfom6�n9 <br /> CONTR.LICENSE# <br /> �t�a2T�J�GoS"s KR �£s1D i!o(r[� �f tiE a� �l��s,� 9'9'ZT� 2(ro 6si �zz <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclnc Gas Other <br /> WORK DESCRIPTION <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilet AIC—airhandlingunits <br /> Balhtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> _ Shower � Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> _ BackFlow 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 /> I CITY OF EVERETt LOCAL SALES SAX CO�E IS 3105 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and corcect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with 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 construcUon or the pedortnance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contract rs Law 18.27 RCW and 296200 WAC. <br /> /��, � ll�,�s >o-ry - o� <br /> Sign�—of�wner/Contractor/Authonzed Agent Date <br />