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�-�RMIT APPLICATI.�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 .7 �-Z,-C�b <br />425-257-881 G- FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />-��`'�ci.� ��i. ��1.1U(Z`C i�%� <br />LEGAL LOT NO. BLOCK <br />DESC. �� � �� �i � <br />OWNER <br />�: fZ �-� 5 � ,ti"1 I %Uc� (�2- <br />TENANTNAME <br />1" v C rf `; .ti.� I ti � � <br />( c, y �, (� O! ( O I <br />('� 2 U SS I'L(- <br />�-cc? i <br />PARCEL TAX I.D. # P M N <br />C�y3`i l(���Cn CC%�C�O F�-l� <br />TRACT OR SUBDIVISION ft <br />�'L R 7 o f �� F cr ,—� V� I 3��� I�,.is, P 3-� <br />ADDRESS �-r � Z�n �, 1`� .CINIZIP PHONE t� z-S- Z jq - <br />L- � L_ l�vc S�' � u Z �'�� �j �?_ G� G I`i y <br />CONTACT FOR PERMIT PHONE `� 1 S 2 S `i `t i 9� <br />��il."2 ...�.ti1�n�o2 <lon�•a 6�+Y,i.:hyn��nef.co�+� <br />7 r 1.� .� R A /��. ✓` �v S G E-MAIL(��FY.; �'t..r.h .r� rnoY <br />�vn�rt��.�vn A� /�O Cd d X ( 1 ��Zb ITYIZIP HON `_oyy <br />F.L�� Cr-TI p� c'1 � y <br />/ILLISorL� Cvrt.'�i2..r7+�ti, /c� L.J� <br />CO'JTR. UCENSE # � i �j �� O G- 2-� "Z .�y 3 4 6- S� 3 I% <br />�a- - - I J i� A � L C I Cj O`'f !-: �i — <br />USE OF BUILDING <br />la�ti� o(�1����e <br />WORK DESCRIPTION <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�j Eleclric _ Gas _ Olher ��C I`-�� S<. G <br />��..i{i,=1 �-�_ % _.� . <br />��p. I TYPE OF FI%TURE OR ITEM <br />� Toilet <br />Balhtub <br />� Lavalory (wash basin) <br />- Shower <br />I Kitchen sink 8 disposal <br />/ Dishwasher <br />Clnlhes washer <br />% Wafer healer <br />-- Sink (service/barlmupletc.) <br />Backllow preventer <br />Urinal <br />Drin4;ing Founlain <br />Floor drain <br />— Grease trap <br />Roof drains <br />— Othcr _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />� AIC - air handlinc� unils <br />r Forced air systems <br />�= Gas piping <br />— Walerheater <br />— Gas (ireplace <br />Gas renge <br />— Clothes dryer <br />Range hood <br />� Ezhaust (an <br />— Heat pump <br />— Unit healcr <br />= Boiler <br />= Refrigeralion <br />— Nbodstoee <br />= Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />i hereby cerilify Ihal I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br />ordinacas �overning lhis type ol work �vill be complied tivilh whelher specitied herein or not. The granting of a pennit does not presume <br />to qive aulhonty to violale or cancel Ihe provision of any oQier slate or local law regutating construction or the performance of <br />conslrurtion. Thal I am authorized by Ihe owner of this property to peAorm Ihe work for which application is made and I comply with the <br />Stalc niraclors La 18.27 RCV` and 296.200 WAC. <br />/1����.��L�=�(.�/�l/�'_ — ��/� /�� <br />I -, <br />�--- .-- <br />