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PERMIT APPLICATIdN <br /> CITY OF EVERETT NERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM "',�_a S � Q� <br /> SITE ADDRESS �jQ�2p� PARCEL TAX I.D.# PERMIT M <br /> ! I aci� ,� � �ur�- �� G'o43 3 0� o0o c�o3 -� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVIS'9N# <br /> DE&C. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �cJ�+�nl !�'r�cQ. IIDo P��i� .4�1� �,,�-� � ��Yc¢a.rr 16201 �1?� 33a-2433 <br /> TENANT NAME CONTACT FOR PERMIT PHONE 4ZS 25�- o6N 8 <br /> �+�Err F.�a�rc. �Jo,�r C�r�lc� I:e�w� r�u-I�a E-MAILI7M4P�•O[YOaeb�hu�+• <br /> n To �b6kE� i � � <br /> �c..Jc.AnJv GchlyrF+��r'IOtY 33c» GU��.rN�t � �Erf 1020( �`}2S� 25�i-�1�t( <br /> CONiR.LICENSE ll <br /> n1�0��343oa <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ✓Electric _Gas Other �'LQb �OdCp,O0 <br /> �R"CAL ry-1D Oi AQL' I�fcNLfLL •`7EN�� — -- <br /> WORK DESCRIPTION <br /> �CGcv.)��(ttJK� ��-�r-�.'- P�-�'^� 7O 6l�WcJ �DI� O("FIC.ES �n1D GUt�IG(.ES <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathtub Forced air systems <br /> ' ovalory(wash basin) _ Gas piping <br /> :'�nower Waler healer <br /> kllchen sink&disposal _ Gas fireplace <br /> UishH�asher ��as range <br /> Clothes washer Ciathes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mopletc.) _ Exhaust tan <br /> Backtlow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinkin� Fountain . _ Boiler <br /> Floor tirain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCA:SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know Ihe same to be true and correct. All provisions o1 laws and <br /> ordinaces goveming Ihis type of work will be cumplied with whether specified herein or noL The granting of a permit does not presume <br /> to�ive authorily to violale or cancel Ihe provision ol any other state or local iaw reGulating consWction�r ihe peAormance of <br /> construdion. ThatJ�am aulhorized by the owner o(this properfy to perform the work tor which application is made and I comply with the <br /> Sfate Con Law 18.27 RCW and 296.200 WAC. <br /> ,,�,��! 3 — �; —a�s <br /> Si;�na r �edConlrector/AuthorizedAc�enl Date <br /> �/.� <br />