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� — — - <br /> ' F�ERMIT APPLICATION <br /> CITY OF EVER�TT PER.MIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTtD FROM 8 AM TO 4 PM S � I <br /> —O� <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT# <br /> 2p2r� lc�� }{ R' • p,4�°j I'�. 2�v�2`la�2o2� � �?��; � _-�o <br /> LEGAL LOT NO BLOCK TRAvC�TLp�n i I ,, L- I ' ,y <br /> DESC. a Q��7�n„�' SLIV'P.�� !NV K, t�� 1`7 <br /> OWNER ADORESS CITY2IP PHONE I M��ydQ <br /> �i l�V W �.�1 I� ��'�i� �.1-(i �1(0`�" ��Gta� �IF�o �ax- � � (�/K�C'��' �a 01y M p a!L '°yc <br /> TENANT NA E CONTACT FOR PERMIT PHONE c0� y <br /> ��� �Cc(�%w11'`�c'"'�') � h'1t''�-� 1 dY''^fx� � • 2c� �7� '(olI�#-- <br /> CONTR T� OR � ���AODR i�N � �� CITY2IP PHONE <br /> �I�:v'w": � ��n ��(GVVL� �(L�'• 2o9'`f�U <br /> CONTR. ENSEt! *��� �, �,(� ZU� ��par�� <br /> vvl•• �wn. <br /> USE OF BUILDINI� I — -HEAT SOURCE ONTRACT PRICE OF WORK <br /> �ctric _Gas Other � (�� �'� <br /> WORK DESCRIPTION <br /> p�-fr,t.iw fz-s�d,c�j r �r�s �v kat�,ios <br /> PLUMBING �,J�lq MECHANICAL /./ �.. <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Balhlub Forced air systems <br /> lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/barfmop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> � Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other _ <br /> � Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerrtify thal I have read and examined lhis applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinac s governing lhis type o(woik will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give au riry to violale or cancel lhe provision of any olher stale or local law regulating construclion cr the performance of <br /> construction. al rr authorized by ihe owner of this property to peAorm the work for which aoplication is made and I comply with the <br /> � State CoMmclor CW and 296200 WAC. <br /> 3�f3�rrl <br /> SignaWre of wn ontractor/Authorized Agenl Date �IZ <br />