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APPLICATION <br />PcRMIT APPLICATIuN <br />CITY OF EVERETT SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ;-�n71 � _Oi <br />znee.�....em+e.=e—�A <br />425-257-8810 -FAX 425-257-8857 - www.everettwa.org �//'► <br />�zs.z++u�v.ruvz. <br />a,h <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM vJ�? <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />13� �EDE�t- AJE <br />E�..dimG1C <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />SEE � =. <br />DESC. <br />RTfALiitv�TTi <br />OWNER ADDRESS CITYIZIP PHONE <br />$00 '12�% <br />v E+c �'v4 <br />SORT OF EJE� EJefzc� V`!A 98•tot.-►r.�t� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />�ei3� <br />fJEam SN�xut <br />tJErz�Tf �t�xr12A <br />�(^� QUI�iL�'i '}2S-Z59— 013�- <br />�J �0�6�¢! _ <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />MTA CIDn�y'rrucliovl Ire. • ,1,,- EdeC�' uJP, gbzs8 <br />c..rdr wn � <br />CONTR. LICENSE# <br />MTACOI—ISO— <br />USE OF BUILDING <br />s•rp2A•GC � WnR.IL <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />METAL C6fE9-ED <br />����� <br />gREh trfl'� 016R.N6R0 CRg116 <br />_.Electric _Gas _Other ar6 <br />:..''`mow <br />WORK DESCRIPTION <br />C(54'S�cT F=oun1!]"GIS FoR t►,s1c(�(2g7gp �UtL..$1�(Ct RAID O�IER�BfS'D <br />c-)ANE sTZ-,w-t-[,tz'-- • cm•cErz �rl,ll_PJ1iJ4 Ta 'r�JtaE D�.y FsIJ��d>�f- <br />F'02 tn/ORx• 044D EQUIW�7Jir �lCa2hGE ZUczaS� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C —air handling units <br />_ <br />Bathtub <br />Forced air systems <br />_ <br />_ <br />Lavatory (wash basin) <br />_Gas <br />piping r, <br />Water heater <br />_ <br />Shower <br />Kitchen sink & disposa; <br />�V <br />Gas firepiace <br />_ <br />Dishwasher <br />Clothes washer �D�E <br />_Gas <br />_Clothes <br />range <br />dryer ^ <br />_ <br />Water heater <br />Range hood <br />Sink (service/bar/mop/etc.) <br />i <br />Exhaust fan <br />preventer <br />Heal pump <br />=Backflow <br />Urinal <br />Drinking Fountain I <br />Unit heater �\ <br />Boiler 1� <br />Floor drain <br />Refrigeration �u <br />i` <br />— <br />Grease trap <br />Roof drains / <br />_._ <br />Woodstove <br />Other <br />_ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. Th ed-�y1�e owner of this properly to perform the work for which application is made and I comply with the <br />S Con 7 and 29 . 0 WAC. <br />1 <br />�1unC 27.� Z� <br />4Date <br />Siyrature of caner/Co lra t u ent <br />I � <br />PERMIT <br />