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Pa-RMIT APPLICATILN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9KO'I <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. # I PERMIT # <br />.2Y(39 K ,39g-2oo2 c7oZoz <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. Z- Z <br />OWNER ADDRESS CI7YIZIP PHONE <br />5"fevGu Welter 2yoq 7`/"sr sE Coerotr �/Z 31'7 %3Z 3 <br />TENANT NAME <br />CONTACT FOR PEhMIT PHONE <br />a-ueu <br />—CONY ACTOR _ -- ADDRESS Crl YIZIF r•nUNI: s 7 p� y7� <br />�ler In c... K'1vr� Co�5.4.�e�t�ti F.c' go- IZ6/ MaY�jrv�lft 58Z�e 7 l <br />CONTR. LICENSE 0 <br />1411-0,1 Ncg33NG <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIP110N A L7.' A ja ( (f,Arc,9 <br />PLUMBING MtUMANwAL <br />NO. I TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />_ Water heater <br />_Sink (service/bar/mop/etc,) <br />_ Backgow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_Flour drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />N'A <br />_ A/C — air handling units <br />Forced air systems <br />Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heal pump <br />Unit heater <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />b <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 />ordinances 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 authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />constructiop. That I am at/horized by the owner of this property to perform the work for which application is made and I comply with the <br />SI� actor ;27 RCW and 296.200 WAC. <br />y / `/- /0 <br />Y', <br />