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r�RMIT APPLICAI ��.N <br /> -1�/ CITY OF EVERETT PERMIT SERVICES <br /> / �� '� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � -�L 425-257-8810 - FAX 425-257-8857 -www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE OT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P�RMIT# ,n <br /> �.CASIND F�O ZvOf'JD, OO�j02?� ' , �/D 7T: <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZ PHONE <br /> JlM t`��.1-L� 12o1�f- 20fh ST � �V�F�it' WAr `F25� 2852 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SANq2C�.� �iCi�G �� � SOI <br /> � � <br /> CONTRACTOR ADORESS CITY/ZIP Pf{ONE <br /> �K�M�U� �����n� n ��{� /]� �y��,�.�. �p�.�-. <br /> CONTR.LICENSE p ( `�rl v" 6� 'N�'4/�I �5 �'LF�✓(� <br /> I���c�1 �G6lb"11''I I�- <br /> USE OF BUILDING � HEAT SOUR I CONTRACT PRICE OF WORK <br /> � f�-�.1-r7� � <br /> 'l�w Z� �s-'��� _[Icc�rir, �G. Other ��� <br /> WORK DESCRIPTION <br /> }.E�1 Gprl-r'stKUCf(oN • (o Ur�Cf� t��l-'ilt�l� . <br /> � t�ti � /� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tnilet A/C-air handling unils <br /> BathWb Forc�d air systr.ms <br /> Lavatory(wash basin) Gas pipiny <br /> Shower W at�r heater <br /> Kilchen sink 8 disposal Gas lireplacn <br /> Dishw2sher Gasrango <br /> _ Clolhes washer Cloth�s dryer <br /> _ LaunAry tray Rango hood <br /> __ Sink�servicelbar/muplotc.) Exhaust fan <br /> Backllow prevenlor Heal pump <br /> Urinal Unil t:�ater <br /> Drinking Foun�ain _ Ooilcr <br /> __ Flnordrnin Refri�cration <br /> _ Greasc Uap Woodstove <br /> Rool drains Other <br /> Othar — ----- - <br /> CITY OF EVERETf LOCAL SALES TA%CODE IS 7105 <br /> I lir,reby ceri�i(y Ihat I havca e�d�nd oxamineA Uiis applic�tion anA know iho same lo be Irue and correct. All provisions o(laws and <br /> ordinac�s rJoverning Ihis pe ot work will be complieA wilh whother specilieA herein or not. The c�ranting of a permit Aoes not presuma <br /> tu give aulhorily lo viol e ur cancel Ihe provision ol any o�h�er slate or local law regulating consWction or the perlormance of <br /> Iconstrur,tion. Tha . �,u iuriri�A by lhe owner ol Ihis properly lo perlonn Ihe work lor which e{•�plication is made and 1 comply wilh the <br /> Sl,�to Cu ra � L f , i 1 CW and '19G.200 WAC. <br /> I _ � _ I� ' �L 'Q✓ <br /> Signature o w �r/ .onlractodAulhonzed Agenl Dalo <br /> � <br />