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i <br /> PERMIT APPLICATIt)N <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 T04 PM / Z�-O�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �2� oAv.ts rtYE� �` Zo0 oo�4soc�zeozc� C�S� 1 - U ��— <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> D[SC. Z�,xy�b�Z��o.��2te�2`\ (cZb <br /> OWNER ADDRESS CINIZIP PHONE <br /> 212� OAK6S LLC. Z� Z� oqKES AV6. EY&¢ET''f/�F�` C4Z5� 'Z55 - O�l.$ <br /> TENANTNAME CONTACTFOR PERMIT PNONE <br /> CclzS� -Zsq-oYy�� <br /> p��SµAv I d^ ZJ SMR+J ANDY HA1..1� t-MAIL <br /> NT A TOR ADDRE 1 I IP NE <br /> PNINN6Y CoJS�TRJcTw�l ING . Ro.BoX 1123 --- EvER�"{'��qty2olo <br /> CONTR.LICENSE p j, �~� <br /> �Xi 5 <br /> USE OF BUILDING TSOURCE I CONTRACT PRICE OF WORK <br /> O�Fi�E _Electric �Gas_Olher $3o�ocr� • o° � <br /> WORK DESCRIPTION <br /> 'r�rv0.�.T� 1MPRoVE1HEN'I' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A�C-air handling units <br /> — 8������� _ Forced air systems <br /> Lavatory(�vash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 dis�wsal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer Ranye hoo�i <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> BacAllow prevenler _ Heat pump <br /> Urinal _ Unit healer <br /> Drinkin9 Fountain _ Boilcr <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> I O�her <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> '� ^.ereby writify lhat I have read and examined this application and I,now the same to be lrue and correcL All provisions of laws and <br /> ,•�;maces poveminp this type ol work will be compiied with whether speci(ied herein or nol.The granting of a permit does not presume <br /> �, :�:e aulhoriry to violale or cancel the provision o(any other state or local�aw re9ulatin9 construction or the peAormance of <br /> .�,�slruction.Thal I am authorized by the o�vner of fhis property lo perform the work for which application is made and I comply with the � <br /> .'at.Coniractors Law 18.27 RCW and 296.200 WAC. �I <br /> ��,.,�t.,� I 1/Y,e/03 <br /> ". �;�ature of Ov+nedCo� t ctodAulhorized A�enl ���� ' ! <br /> �Z J <br />