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� <br /> P�RMIT APPLICATI(.�� ���� <br /> CITY OF EVERETT PERMIT SERVICE �oso7- � �$ <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 TO 4 PM -DEBR 6 CREDR CAROS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D./ I PERMIT• <br /> �o ��err-� ,r�= Xo5D7-ULC) <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PMONE <br /> I�En'1C, �AC�Fr�- CI�,�'lPvs 9i� �A-�rG�� A�I� E✓C^iec�-�- 9�Zo� <br /> TENANT NAME . _ CONiACT FOR PERMIT PNONE <br /> � CJEr�c�-T C�,��� I /'/i�F /J��/�i�✓,J�l' �o - zo� -98��j <br /> CONTRACTOR ADDRESS CITY?.IP PHONE <br /> �irkw�o,�� 3 C�o�s���-��s 3y3� A,rzpo�T �R- c�-���U�n�n 36� <br /> CONTR.LICENSE ytjZ�,� 73�-�3�00 <br /> �Si�qr70�3CC vlo� L/� <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �^,�'h``�'�5� � <br /> �L'D��•�' C'.r-}�`�Q��JS (�/��/�wp _Electric _Gas k Other ��� <br /> WORK DESCRIPTION <br /> 2caocan: �7t�snnlci ,Z �Js � 1 ss s���= . <br /> R��oc.A-ii ��(Isnn1�1 D�1�7yJoRK - h+�n �- T� CSoJ( -+ C7�'��[. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F�XTURE OR ITEM NO. 7YPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling units <br /> Bathtub _ Forced air systems <br /> Z Lavaiory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposai _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundr�tray _ Range hood <br /> � Sink(serv�ce/bar/mop/etc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Reirigeralion <br /> i Grease trap _ Woodslove <br /> Rooi drains __ Olher p.�� � r� 30,( <br /> Other — <br /> CITY UF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcl All provisions ot laws and <br /> ordinaces governin� Ihis type of work will be complied with wi,� lher specified herein or noL The granting ot a permit dces nct presume <br /> lo give author't�lo violate or cancel the provision of any other state or local law regulating construc�on or the perfortnance of <br /> conslruclio hat I am aut�ori d by ihe owner of this property lo peAorm the work for which application is rnada and I comply with lhe <br /> State Co act6rS aw 18.27_ CW and 296.200 WAC. <br /> �� ,��,! �� � 7/Z 7/OS <br /> Sign re of OwnedC�6ntractor/Autho j d Agent D le <br />