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Pi�Rn�IT APPLICATI(,�V <br /> CITY OF EVERETT PERMIT SERVICES �,�jq <br /> 3200 CEDAR STREET, EVEP.ETf, WA 98201 n� � <br /> 425-257-8810 - FAX 425-257-8857-www.e�erettwa.org {l <br /> 1 <br /> APPLI�ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> �� 0 7 , �•�. 3l z o s 3ou �/�oo - <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ��� n , <br /> OWNER Y�'� <br /> ADDRESS CITY2IP PHONE <br /> �%%� f?����..��LL� P,O, ,r�nX 9/o CL/n/1'o.�/ 982�6 ,3�-3Y/ v o y <br /> TENANT NAME I .ONTACT FOR PERMIT <br /> PHONE <br /> .Te"� �-�.., ,360 9.�9 -�s.�� <br /> CONTRACTOR ADORESS CITY2IP PNONE <br /> /(a 0.�'�-�C'�.�Lc C '_ <br /> C9NTR.LICENSE# <br /> _ �A�t',�cLfailld �,%D/��(9/D C�i.vf,s, ygzJ[ 3�G -3yfYlo4 <br /> USE OF BUILDING I HEAT SOURCE CONTRACY PRICE OF WORK <br /> S-Giu„4' /—Dlh-vF _Electric I� Gas_Other I �'f�U U <br /> I WORK ESCRIPTION <br /> I �'T����� sr ,e.��.-� �,3� <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. <br /> TYPE OF FIXTURE OR ITEM <br /> 3 Toilet <br /> � Bathtub A/C—air handling units <br /> T Forced air s stems <br /> Lavatory(wash basin) Y <br /> Shower Z Gas piping <br /> � Kitchen sink& disposal �_ Water heater <br /> � Dishwasher � Gas fireplace <br /> � Clothes washer � Gas range <br /> Laundry tray Clothes dryer <br /> — � Range hood <br /> _ Sink (service/bar/mop/etc.) �_ Exhaust fan <br /> _ Backflow preventer Neat pump <br /> Urinal <br /> i Dri�king Fountain _ Unit heater <br /> B�iler <br /> i � Fioor drain _ Refrigeration <br /> Grease trap Woodstove <br /> I = Roof drains _ Other <br /> Other <br /> � — <br /> � CITY OF EVERETi LOCAL;,ALES 7AX CODE IS 31D5 <br /> i I hereby ceritify that I have read and examined this application and know ihe 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 regulating con�truction or the performance oi <br /> construction. That I am authorized by the owner of this propeny to perform the work for which application is made and 1 conply with the <br /> State C�trac;ors Law 18.27�CW and 296200 WAC. <br /> � /�i!��t����l y-.�� os <br /> I Signature of OwnedCo racronAuthonzed Agent Date � <br /> I i/� <br />