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P�tRMIT APPLICATIbN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CED.4R STREET, EVERETT, WA 98201 <br /> 4�5-257-8810 — FAX 425•257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> 14 o W CpS"�a�n p�p��p - ��t ocr365'l Olo lol 00 Q ����' �' � <br /> LEGAL LOT NO. BLOCK TpACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADORESS CITY/ZIP PMONE <br /> �MI.'l�-s�'t' �i�.k, CcNoornuJ;�Ms 143D W�sP� �V �ft�SC °i82o`} <br /> TENANT NAME CONTACI'FOR PERIM'IT, PHONE � 662 �11 <br /> �SL'C �'D(lk I JIN�IIG�`it� FI,t.D�+� ���-Ma�JiM@�alDdfiuAC4i1Qlxf. <br /> aaarrsbi �D Es�---- � <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE CONTAAC'f PRICE OF WORK <br /> (,G1��1ti1��y�1'� Eleclric Gas_ . Olher � `(V�O� �— <br /> WORK DESCRIPTION <br /> kt�E � ��E slo»sc� t� � n.��.a� �.tJ�.oP� a+�MRS <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURF OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> Toilet • . • , �.,T_ FVC=air handling unils � <br /> �athtub � � � � � ' ___ Forced air systems <br /> _ Lavatory(wash basin) __.._ Gas piping <br /> Shower __ Water heater <br /> __ Kitchen sink h di,posal __._ Gas fireplace <br /> Dishwasher _ Gas rangc <br /> Cbthes washer _. Clolhes dryei <br /> � Water heater __ � Range hnod <br /> Sink (service/badmop�etc.) __ flxhausl lan <br /> _ Backllow prevenler __ Heal pump <br /> Urinal ___ Unit hcater <br /> _._ Drinking Founlain _ Boiler <br /> Floor drain __. Refrigcration <br /> _ Grease Irap __ Woodstove <br /> Rooldrains .__ Other <br /> --- Oiher —_ --------- <br /> CITY OF EV[HF.TT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know Ihe same to be trua and correct. All p!ovisions ol laws and <br /> ordinaces goveming this lype of work will be complied with whether specilied herein or not.The granling ol a permit does not presume <br /> Io give aulhority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> conshuction. That I am authorized by tha owner ol this property to perform Ihe work lor which application is made and I comply wilh ihe <br /> St Conhactors Law 18.27 RCW and 296.200 WAC. �7 <br /> W CR 23 <br /> � nati e ol O ier� 'oniractonAu�horized Agenl ate II� <br />