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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—vwvw.evereriwa.org 8_y�y <br /> APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX/I�y��J1/ 2 PERMIT N ` � <br /> I L D�� Ne.w,r, Av� �1N- i=�ur,� ,) �"7/ C��JQ� �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OMMER ADORESS CITY2IP PMONE yZ5 _ <br /> Sk0-�L74�- QfA l. C :lA.�. <br /> .1-�.r.+�u�?'7' <br /> (?O. 3ox 52�.� E�Eee�T' qBzoca zs'z -`�yoo _ <br /> TENANT NAME I CONTACT FOR PERMIT PMONE <br /> WE��s �AQt <br /> I .�J'�"Ti�.f �Jf�N� � z.53-'d93-3�Z-� <br /> CONTRACTOR C�.�T& Cor�raG4c �n� ADDRESS Z/�o OS) C�TYIZIP PHONE <br /> t-c��J�Tr�Fl�lir�1(� �� r � <br /> CONTR.UCENSEk $ 4 �.IL� I'�EE�<GQ ���_ }�E,,�; `I $03Z 2S3 `393 - <br /> f_l.7_'i�Cc.2Uc.p 3�00 <br /> USE OF BUILDING I — NEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric �Gas Other � S � (�OU <br /> o�-A�E sPa�..� ' <br /> WORK DESCRIPTION <br /> I 4�'c CJf�STiiu(` p�=���:�. TS 26��,00�.6 , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> - Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Ges piping <br /> Shower - Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mopletc.) Ezheusl fan <br /> BackOow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain - Refigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby cerility that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> urdinaces goveming tl�is type of work will be complied with whelher specified herein or not.The gra�ting of a pertnit dces not presume <br /> to give aulhonty to viola e or cancel ihe provision of any olher state or local law regulating consirud��n or the perfortnance of <br /> construction.Th I a authorized by the owner of this property lo peAorm the work for which epplication is made and I comply with ihe <br /> State irad 18.27 RCW and 296.200 WAC. <br /> lh�- . 7 2'7 ���� <br /> igna re of Owner/Co cr/Authorized.4gent Date �/ <br /> L <br />