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P�r2MIT APPLICATIG�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25�-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> S17E ADDRESS PARCEL TAX I.D.p PERMIT p <br /> 919- /o5^' S1 s � moyi�-oc7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AOORE53 CITY21f}�,Ly`� PMONE -- <br /> CC � hef�r�ti �m ��be �� 9� 9-/n`r~sfs � �v��r� f-I- �.53 9�//f <br /> TENANT NAME ` CONTACT FOR PERMIT PHONE <br /> � S �-�-�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N S I 1 Y1'�'�--" <br /> USE OF BUILDING I — NEAT SOURCE I CONTR4CT PRICE OF WORrC <br /> Electdc Gas Olher <br /> WORK OESCRIPTION � ��S �Yt �� C,G�S .�-'�2'- ����i� �' � r'lSC'f � <br /> / <br /> PLUMBING MtCHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. �fYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handling units <br /> _ Balhtub Forced air syatems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water hoater <br /> Kitchen slnk 8 disposal Gas flreplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Ciothes dryer <br /> _ Laundry tray Range hood <br /> Sink (service/6admop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heatar <br /> Drinking Fountain Bofler <br /> _ Floordrain Re/rigeratlon <br /> _ Grease trap Woodsrove <br /> Roof drains Olher <br /> Other — <br /> I CITY OF EVERE7T LOCAL SALES TAX COOE 19 NOS <br /> � <br /> II hereby ceritify that I have read and examined this application and know the same to be true and carrect. All provisions of laws end <br /> ordinacns governing this type o(work will be complied with whether specified herein or not. The granting nf a permlt doee not presume <br /> to give authonty to violale or cancel the provision o1 any olher state or local law regulatlng consWctlon or the peRortnance of <br /> con ru tion. That I am aul ¢ed by the ownei of this property to perform the work for which application is made and I comply with the <br /> St e CoIntrac�t .rs Law 1 .27 F�'CW and 296.2 AC. <br /> ��""- �'� � 9 0 <br /> Si naNre o wnerr o tonA honzed gent 8 <br /> � <br />