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-� <br /> PERMIT APPLICATION <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 FHOM B AM 7'O 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. PE MR <br /> 2918 �.$'� �cu� . 4�4�39��aze2bce o0439�6a2o � �(�- t��S <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION/ <br /> oEs�. zs 2q 30 �8Z'p-oo <br /> OWNER ADDRESS CfTYlZIP PMONE <br /> LYNNM�d <br /> G�NOFIflM�h{� Lp. (,Ot.$y �/�MILN '��btS'r p.o.gox 553 qR o,f,� <br /> TENANT NAME .{- COHTACT FOR PERMIT PMONE 4j„�� ZS Z�L15�j <br /> �/�UI��F} �s`�/ rit� I ��.�..2,uh�R(c.��r�iT'��T�U�R`� -� 1�� <br /> 1 ' ' t�f�r-v-1 I�V[�I,icr+�c�d E�MIAILQeYo`Ie.ZSIL�MG� �d <br /> � <br /> QuM�I"f`f IM('RoV�i� C,o. 292o Cnt.p�Y l�vt. ,�Yb'itE'PC- . Z�b-(oSb`L <br /> CONTA.LICENSE M � G��l ITY� ��J� q 8�I <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���C.0 #Electric _Gas_Olher � 7���� <br /> WORK DESCRIPTION <br /> T�+.�c-r �M��v�n�-r - � a�c.� s� �►�+ �t�T ��°►'z • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%NRE C�A fTEM NO. TYPE OF FlICTUNE OR ITEM <br /> _ Toilet A/C-air hardling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) Gas pping <br /> Shower Waler heater <br /> _ Kitchen sink&disposal Gas lireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washar Clolhes dryer <br /> _ W a�er t�eater Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust lan <br /> _ Backflow prevenler Hea1 pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> _ Floordrain Refrigeralion <br /> _ Grease Irap Woodslove <br /> Rool dreins Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceri�ity that I have read and examined Ihis applicalion and know the same to be Irue and correcl. All provisions of laws and <br /> ordinaces governing Ihis type ot work will be complied with whe�her specified herein or not.The granting ol a permit dces not presume <br /> to give authority lo violate or cancel Ihe provision ol any other slate or local law regulating construction or the pedormance of <br /> construction.Th I am autho ized e owner ol this property to perlorm the work for which applicalion is made and I comply with Ihe <br /> Slate Conirac rs law 2 an 2S .200 WAC. <br /> �•02•0 <br /> Sign ure ol Owner ontractodAulhonzetl Agent Dale �/, <br /> ` <br />