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t � <br /> PERMIT APPLICATION �� `� �� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREEf, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS 5�;�t� PARCEL TAX I.D.N PERMIT N � <br /> 114� 1 A �r c� ��� , tvzfr,�bF oo53}y0000S3�o /� iDo�- Da� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION <br /> DESC. C -�` � ' J ��IQN I �1IU <br /> OWNER ADDRESS CI7 V21P PXONE yZs_ <br /> p ���;�i A�rpo;+ P�R, <br /> /Y1��etz�� 6L�5;nP�c.slark, l��C � . � 6_ � t��r,�f �zoY 21z- zy90 <br /> TENANT NAME ,�C^ONTACT AF,O�R PERMI7 PMONE�ZS-�S/- / �:5I <br /> ��E�-�� L�V�C/J � �l�l� / , 11 I'�- /' II'Cj�ZNl� � E*IAIL '-- <br /> � R S$ �`I I XONE <br /> �,� Z�r ���,� ��k, �� ���r� y2s-Ziz - zyyo <br /> CONTR.LICENSE/1 <br /> ���-�z�P 53y �- K ��� �-�z -�I <br /> USE Oi BUILDING HEAT SOURCE CQNTRAC�RICE OF WORK <br /> � O�� `/ � G ndr•. BC1 <br /> � �� _Eleclric 1�Gas_O[her � Q dIJ U <br /> WORK DESCRIPTION .i nM n` -Q- � „_ !f a ��x� ��.. ��j�f�`O �i�� ,Q IL(�S'�S <br /> ri/ �G✓'Ut i�-���� f✓ Y <br /> �� <br /> PLUMBING �1AECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet -- A/C-air handling units <br /> - Bathtub � Forcedairsystems <br /> � Lavatory(wash basin) � Gas piping <br /> � Shower � Waterheater <br /> Kitchen sink&disposal �-- Gas f replace <br /> �_ Dishwasher _� Gas range <br /> Clothes washer Cbthes dryer <br />. Z Water heater — � .2ange Frood <br /> _ Sink(service/badmopletc.) �__I Exhaust fan <br /> BackFlow preventer - Heat pump <br /> Unnal Unit heater <br /> _ Dnnking Founlain � �- Boiler <br /> Floordrain � Retrigeration <br /> Greasetrap . - Woodstove <br /> Roof drains pther <br /> Other <br /> . CITY OF EVERETT LOC/LL SALES TAX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know the same to be We and cartect. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not pres�me <br /> to give authority to violate or cancel the provision of any other state or local law regulating constn�ction or the performance of <br /> construction.That I am authorized by the owner of this property to peAorm the work for which application is made and i comply with the <br /> State Contractors La 18.27 W and 296. 00 WAC. <br /> ���� � �/'� �'� -{ 7�-/Q � <br /> Signature of OwnedContractor Authoriz Aggnt Date i�z <br /> ^p /1 <br /> �„Z`�Z,,� T7U'7��� S� � C C � <br />