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� � <br /> PERMIT APR�ICATlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 f/..-�j..f(� <br /> 425-257-8810- FfJC 425-257-885? -www everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRONi it AM TO 4 PM � �0�,`�� <br /> SITE AD7RESS PARCEL TAX I.D.A PERMIT# /� <br /> ( ��OZ �1��ZF.t}'.�( lAW`1� po 4U� 003�1000 /f�(l�U S�j <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. a � �� _ •Go =/,�T(o <br /> OWNER ADDRESS I:ITY/LP PHONE <br /> Ccl ,�.b •� 51 �e $>n� .S�/c > �y � S�- w 51e F_lake�crxQ WP 9Ky99 <br /> TENANT NAME CONTACT FOR PERMIT PHONE'L�j�j (�,Z� "�l.,f��j <br /> I JIM S"f1U. e.M..i�J�M2�FRf'.tCSt{Fi4T'A'� <br /> 1�R1�UUS f'IEATIIJG 4 1'c/G S lZl -li• gV�IIJ��TTcr1 WiqY ThCcYr°� �"i3 G2�1 ?5�3 <br /> CONTR.LIC NSE 8 ��pCy <br /> NP�RoI�216.J3 — <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��M�� �Electric _Gas_Other �8�Z?j ^ <br /> WORK pESCR�PTION , <br /> ��,� s�PP��r q p�eru�,.� �c� Puas <br /> 1� NEtJ pCi;a.UST 1`na� u A�('M RvoM <br /> NEw c�c's �R�vx�. Ti�wos� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ PJC—air handli�5g units <br /> Balhtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher __ Gas�ange <br /> Clothes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink (service/badmop/etc.) _� Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater I <br /> ✓rinking Fountain _ Boiler <br /> Ftoor drain _ Refrigeratio^ <br /> Grease trap Waadstove <br /> Roof drains �J _ Other REI�tA� �K <br /> Other X � NEV 6 R-D• <br /> _ ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this applicalion and knc,w lhe same to be true and cortect. All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cance�the provision of any other state or local law regulating consiruction or the performance of <br /> consiru lion. at am authorized by the ownei of this property to perfurm lhe work tor which application is made and I compiy with the <br /> S e C ntra ors aw 1827 RCW and 25u.200 WAC. <br /> ign t re of edCoMractor/Authorized Agent Cate <br />