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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-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT <br /> I W �FS� D �o�� - 21 oab651 0 lol Q '�0�- `��- <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �QW;R.SE't` �',4�.k Cd�oornirJ;�Ms 143� wCp�s1� 1� �ft�CitC °I82o�} <br /> TENANT NAME CONTACT FOR PERMIT, � " PHONE � 662 *dLl I <br /> JI1^�NG�'Y� ��Lpu�►+ ' ^'�`��MAILJIM(d�dINqQ41�Q'1�7f• <br /> –�� ��'kD � / C� — <br /> �� <br /> CONTR.LICENSE p <br /> USE OF BUILDING I NEAT SOUFCE I CONTRACT PRICE OF WORK <br /> � � _.. °� 2� 500 000� <br /> C01��1�'�����m Electric Gas ___ Cthcr � <br /> WORK DE SCRIPTION <br /> k�fE � t�F�P�E sio�►s[; R� � r'�La'� �uJ&�PE R�e�rzs <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> ,__ 7pilel �� . ` . . �. ,. , � ' . ..^ AiC--air�handling uni�s ' � • � . <br /> Qnthtub � .__ Forced air systems <br /> _ Lavatory (wash basin) __. Gas piping <br /> Shower ,__ � Water heater <br /> � Kitchen sink 8 disposal _... Gas fireplace <br /> Dishwasher _. Gasrangc <br /> Clothes washer __ Clolhes dryer <br /> Waler heater ___ Range hood <br /> ,. _ Sink(scrvice/badmop�cic.) _ _ Exhaus�fan <br /> __ Dackllow preventer ___ Heat pump <br /> Urinal ._. Unilheater <br /> __ Drinking Faint�am _._ BOiler <br /> Floor drain __ Relrigeration <br /> � Grease trap Woodslove <br /> � Roof drnuis . . Other_ ._ <br /> Other -- . ------- -- <br /> CITY OF EVERETT LOCAL SALES TAI(CODE IS J105 <br /> I hereby ceritify that I h�ve read and examineC this applicalion and know the same to be true and correcl. All provisions of laws and <br /> o�dinaces governing Ihis type ol work will be complied with whelher specilied herein or not. Tho granling ol a pe�mit does not presume <br /> to give authority io violate or cancel the provision ol any other stale or local law�egulaling construction or the perlormance of <br /> consiruction, That I am authorized by tho ovmer of Ihis property lo perlorm the work foi which application is made and I comply with the <br /> SI Contractors Law 1827 RCW and 296.200 WAC �p? <br /> �j U� 23 1 <br /> nau e ol O ier omractonAuthorized Agent ate l/J J <br /> I <br />