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� <br /> PERMIT APRLICATION <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 N�A TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMR X <br /> aao6 �� 5�. vc� 49� I o001ay oo ���-bs� <br /> LEGA LO7 NO. BLOCK LeACTOOR SUBDIYISION N <br /> DESC. � �4 P P�K O i� �- <br /> OWNER ADDRESS CITY2IP PMONE <br /> l,� a� e QoWe,rS aaoG 6 �� ST. EVer��}-t WA. 9�dol ��-s -�6o -6z�9 <br /> TENANTNAME CONTACTFORPERMIT PHONES(�,rnQ <br /> �,n,�� I sam e e�a�D BotJ et5 G� c;.er�i.rr.�„� .bS <br /> �I/On�, 7 <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> a - GG�� �a(!�(�, � I _Eleciric __Gas_Olher �!/� �� r �1 aU �� (� <br /> J <br /> WORK DESCRIPTION e �� � I I , Q U± �� �i-�• � <br /> Po�f n �, I�(i4e y � bu; o�,ny siUb v ln,i /��� <br /> (�0•� U.� 2, <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FlXTUflE OR IIEiA NO. TYPE OF FlXTURE OR ITEM <br /> Toilet _ NC-air handling unils <br /> Bathtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Vdatcn c�ater <br /> Kitr,hen sink 8 disposal _ Gas fireplace <br /> Disnwasher __ Gas rangc <br /> Clothes washer __ Clolhes dryer <br /> Waler heater _ Range hood <br /> Sink(service/badmop/elc.) _ [xhaust lan <br /> E3ackflow preventer __ Hea�pump <br /> Urinal __ Unit healer <br /> _ Drinking Founlain _ Boiler <br /> Floordrain _ Refrigeration <br /> Greasc lrap _ Woodslovc <br /> Roof drains _ Other_ __ <br /> Other___._—. — - <br /> CIN OF EVEREfT LOCAL SALES TAX CODE IS 3105 <br /> I hareby cerilify�hal I have read and examined this applicalion and know Ihe same to be We and correcL All provisions ot laws and <br /> ordinaces governing Ihis rype of work will be comp�ied with whelher speciGed herein or not.The granting ol a permit does not presume <br /> to give authority!o violate or cancel the provision ol any other slate or local law regulating construction or the performance o( <br /> construction.That I am authorized by the owner ol this property to pedorm the woik lor which application is m2de and I wmply with the <br /> St Con actors L/�y/}' 1827 RCW and 296.200 WAC. (-7 <br /> � (�1 f� �`j J�,r.I �J �-/���/ � � j I r� /i <br /> SignaWre ol OwnedConiraclor/Authonzed Agen� Date <br /> '(Z <br />