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PcRMIT 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />P MIT # <br />, � W <br />(�5719 o <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. 11 <br />1 <br />1 6a,5fQt <br />OWNER ADDRESS CITY2IP PHONE <br />hc._.-:s±&-R N) %�?g Stj �erc <%. s 3 53.5 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�,% L <br />' lo._ .... S -4 f�. I -4 hbLJ <br />CONTRACTOR W ryN—�i<GN-IdrIJFS,.ADDRESS F2�y' AvC�S PHONE <br />.3Stft <br />L—LL <br />CONTR. LICENSE p 4 rC 14TO 9 7 7 D U <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />% <br />� Electric Gas Other <br />— — <br />WORK &SCRIPTION <br />I50 5f. Lf-.Utior)Y 12ov" <br />y <br />' A . � r' rm3o S,F. GA2ACP,- ANA A-ML <br />S'(o o - C3rTA LE <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatrry (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventor <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />= <br />= <br />_ <br />_ <br />_ <br />_ <br />_ <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true an^ correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The - anting of a permit does not presume <br />to give authority to violate or ancel the provision of any other stale 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 />StatAactors Law 18.27 RCW and 296.200 WAC. <br />Signature ol / uthonzed Agent Date I I L <br />