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� P�RMIT APPLICATIbN <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 B AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT <br /> I W �PS� D �a�'D - 2 � oc�651 D lol 00 Q 70�- `� <br /> L[GAL LOT NO. BLOCK TRACT OR SUBDIl9S10N N <br /> D[SG. <br /> OWNER AODRESS CITV�ZIP PHONE <br /> SoMr�s�r �Pi�k C�oom�r�;�Ms �43a Wq,s�� � �f�tC °1a2�} <br /> TENANT NAME 1CONTACT FOR PEHIM'IT� ` - PHONE � fpdZ T�I I <br /> �� C�� I JI1�1✓�WG PY� F�LLD�I'� ' TM`� � "E-MAILJIM(��J[Nf144{�Qx'lS. <br /> L`bATFibL �D SS i — �THONE <br /> CONTR.LICENSE N <br /> USE OF BUIIDING � — HEAT SOURCE CONTRACT PRICE OF WORK <br /> (,O�ItYi/N�►���h'1 Electric __Gas __Othcr � 2 5�� ��� <br /> 1 � <br /> WORK DESCRIPTION � <br /> {ZS�1c.�JE ( �G(�,AL6 SID� � � P.�LPts(� �`/.�I��L� P.Lf't�M2S <br />' PLUMBING MECHANICAL <br /> NO. TYPE OF FIKTURE OR ITEM NO. TYPE OF FI%TURE OH ITEM <br /> � Toilcl . , . , � ; ___ !VC-air handling unils . <br /> � g�p��i�� ' ' _ �Forced air systems <br /> Lavalory(wash basin) ___ _ Gas piping <br /> �� Shower __. Walerheater <br /> Kitchen sink R disposal _.. Gas Iheplace <br /> Di;hwashcr Gasrange <br /> Clothes wa,hcr _. Clo�hes dryer <br /> � Waler healer _ _ Range hood <br /> Sink (service/bii�mop etc 1 __ Exhausl lan <br /> _ �ackllow prevenler ..__.� Heat pump <br /> Urinal ___ Unit heater <br /> __ Drinking Fo�mtoin ___ _ Boiler <br /> Roor drun __ Refrigeration <br /> Greasc trap Woods�ove <br /> ._ . Rool drains _ . Other-- _._.._ <br /> Othcr <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby terility ihat I have read and examirad ihis application anr�know Ihe same to be irue and correcL All p�ovisions of laws and <br /> ordinaces goveming this�ype ol work will be complied with whether specilied herein or noL The g�anting ol a permit does not presume <br /> lo give authority lo violale or cancel Ihe provision of any olher stato or local law regulaGng construction or the pertormance of <br /> constructlon. That I am aulhoiized by tho owner of this property to perform the work for which application is made and I comply with Ihe <br /> St. Conlractors Lew 1827 RCW and 296.200 WAC. �7 <br /> � fJ� 23 <br /> ' nali e of O ier� �oniractonAttlhonzed Agent ate <br /> I _ _ - -- _--- ---------- II� <br />