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PE. IMIT APPLIGATI4. � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 /� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �/, �,�„� ^/,� <br /> u,c.,� i.� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM l'O 4 ?M - DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD�RESS PARCEL TAX I.D. # PE MI'i# <br /> �s z � s ''f ,/��, � ��Ul 'Dl`� <br /> LEGA � LOT N 0. BLUCK TRACT� �� <br /> DESC. ��I <br /> / v <br /> OWNER ADORESS � CITY2IP PHONE <br /> /Q 4/� /',�,,�GW.�+E� ,CL c � �2 3 c , <br /> ` ���os �i� yzt-zs� srz � ,� � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> 'T-��} �-Qo-„ .i 6 0 - Y.Z y -/ 9 S�' <br /> �R���TQ� G� / L�� ADDRESS CIN21P PHONE <br /> /f r. i� <br /> CONTR. LICENSE# y� 2�` <br /> Pr�.��f-�c � o i z� a f/o/�.n yio c�P,.� 3E o-3 �Y-5�6� -� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� �— p�,,ti� _Electrc �j Gas_Other I 9 �� � p o <br /> WORK DESCRIPTION <br /> 11(.A.�� h�v�.�, - S, F �, <br /> PLUMBING � /�� � _ 2 <br /> MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C—air handling units <br /> � Bathtub / Forced air systems <br /> Lavatory (wash basin) � Gas piping <br /> � Shower � Walerheater <br /> � Kitchen sink& disposal �_ Gas fireplace <br /> Dishwasher Gas range <br /> I � Clothes washer � Clothes dryer <br /> i _ Laundry tray Range hocd <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> � BackOow preventer '-leat pump <br /> i = Urinal — Unit heater <br /> Drinking Founlain i <br /> Floor drain Boiler <br /> _ Grease trap _ Refrigeration <br /> j Roof drains _ Woodstove I <br /> � Other _ Other <br /> i — — _ <br /> ' CITY OF EVERETT LOCAL SALES 7AX CODE I5 3105 <br /> I hereby ceritify that I have read and ezamined this applicalion ar�d know the same lo be true and correct. All provisions of laws and <br /> � ordinaces goveming this type of work will be complied svith whether specified herein or not. The granting of a permit does not presume <br /> to qive authority to violate or cancel the provision af any other state or local law regulating constructioo or the performance of <br /> construction. That I am aulhorized by the owner of this property to perform the work for wnich application is made and I comply with the I <br /> State Contractors La�v 18.27 RCW and 296.200 bVAC. <br /> � ��_ i <br /> „�//2�°s � � <br />' I Signamre of Osvneri on racto:�Author.zed Agent p� �a I <br /> � <br />