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PERMIT APPLICATION <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2524 51 TH 61. 6U,EVEReTr,98203 008135 Coo 029 OO <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. '29 000 n- POWDER MILL HIGHLAt406 AIV. 1J0.2 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 0ANICL AND EVAi,I(3ELl41E GAM 2524 5-ITH ST. 5W EVERE T,99203 (425) 321.2k90 <br /> TENANT NAME CONTACT FOR PERMIT FHONE <br /> DAIl (42 5)32-1-269e <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE U - <br /> USE OF BUILDING — HEAT SOURCE CONTRACT PRICE OF WORK <br /> SINGLE.�'AMIL`( {ZEbIDEL (TIAL Electric v/ Gas—Other <br /> WORK DESCRIPTION <br /> -15 -TIOO X%5TlQG 2-bTY. l0t=-QCt TO It4CLOt4EU <br /> ADoTDFJ ANO AL � <br /> Ftat-{ILS R(t, 1 f A14 E1.lLNaCAEr� K-ITCN�N OW TNV- FIRbT FLOnR ANr> ALTE.Rb, in 1b <br /> 70 -THE 6rC0NC> FLOC t TO ttJCLUC>E EWL4W-4EIJ BEDROOrib 4 A OEkA BATHRCOH., <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1= Toilet 11 A/C–air handling units <br /> BathtubForced air systems <br /> Lavatory(wash basin) -t Gas piping <br /> Shower I ) Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> i Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Water heater I Range hood <br /> Sink(service/bar/mop/etc.) ,4 Exhaust fan <br /> _ Backflow preventer I_ Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor draln Refrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type o, work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Stale Contraoqts Law 1 8.2F RCW and 296.200 WAC. — <br /> Slgn ure of Owner/Cont ctor ed Agent Date 12 <br />