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PE� r2MIT APPLICATIO��J <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 ACCEPTE <br /> Kcz4,o -g d 8- <br /> SITE ADDRESS fv/� �'A/D�- PARCEL TAX I.D.# PERMIT# <br /> l/�l�f /9f�J BaVe. S.E. t��}'�D-'r9/3 <br /> LFGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> TENANT NAME CONTAC7 FOR PERMIT PHONE <br /> A�r�rican �,/s/�Yn� JhoP I �'�h� DP�'I��fi,;� �1S-y�q'-16o9 <br /> CONTRACTOR ADDRE55 CITY2IP PHONE <br /> Merrury sprii�k�c�r' C'n� /�c. Po�r�aX ��o� �rimvre y-�s-�9-��y <br /> CONTR.LICENSE#ME�CU,f'L' �27 DE �� ��1" C��� 20�-7�J.� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �' "'�/ Electric Gas Other �Z�•�d <br /> WORK DESCRIPTION <br /> i��ri/i /��'1' �P�'i��'"' ���s thr��qhovf fi�,�bc� mvf .r�/! s�4�e. <br /> /l .t��i/��/ers t�I�l. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> _ Toilet A/C—airhandlingunits <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 /> _ Sink(service/bar/mop/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 _� SP //! J YD719 <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis applica6on and know the same to be true and correct. 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 authonty to violate or cancel the provision of any other state or local law ragulating construction or the performance of <br /> constru io . Th t'f�m aut fized by the owner of this property to perform the work for which application is made and i wmply with the I <br /> Stat 7 r ct rs I!a nd 96200 WAC. <br /> ��f ���O� <br /> gnature of Own ontracrodAuthorizetl Agent Date Ii <br /> I I <br />