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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 FROM B AM TO 4 PM � ..a S•./� <br /> SITE ADDRE88 PARCEL TAX I.D.N PERMIT M <br /> 1 / �� r UO D � 0 7Dl/ - z� <br /> LEGA LOT NO. BLOCN TRACT OR SUBOIVIlION M <br /> DESC. <br /> ER ADDR 8 CI /ZIP P O E <br /> Rob�rt St, cla;r y7/6 A /g���4v�. Evrrrt�- 9B�v3 y�s,�S.�- 9�0,? <br /> TENANT NAME CONTACT POR PERMIT aHONe y,�f- 30p- 6.9y� <br /> I G�nt �vrne /� EiIAIL <br /> NSA 1'/�Ci �OD. �90X �i/'!7 S.'�vA'ww �1�F9' �/.2S-30P•6�'Y9 <br /> CONTR.LICENSE N U S�I INI *�J.?SBC �/Q/// <br /> ✓ <br /> USE OF BUILDINO I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S, F, R, _eie«d� �'oae_ nme� ,,�6 000 ' <br /> WORK DESCRIPTION <br /> 2r1Sf'A�� EX7'��'�or l,OOr infD G•yS�/r��'a � �'n �/�. :,ry <br /> /Pr�s►.�n��.r fs h/A��IJ JTqirt � /�4����HfJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FUfTURB OR ITEM <br /> follet _ A/C—air handl(ng units <br /> Belhtub _ Forced elr eysteme <br /> _ Lavatory(wash besin) _ Gas plping <br /> Shower _ Waler heater <br /> Kitchen sink d disposel _ Gas Breplece <br /> Dlshwesher _ Gae renge <br /> Clothes washer _ Clothea dryer <br /> Water heeter Renge hood <br /> Sink (servicelber/mc,p/elc.) _ Exhauet fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Founlain Boiler <br /> Floor draln _ Rehlgeratlan <br /> Grease trap _ Woadelove <br /> Roof dreina _ Other <br /> Other — <br /> CITY OP EVERETT LOCAL 8ALE8 TAX CODE 18]106 <br /> I hereby coAify that I have read end examined thla applicallon end know lhe aame to be true end corred. All provislons o(la�w�and <br /> ordinances governing thia type of work will be complied with whether speeifled herein or not.The grentinp o(a permil does nol preaume <br /> to give authority lo vldate or cancel the provision of any other stete or locel law regulating conatruction or lhe performance of <br /> construction. That I em euthorized by the owner ol this property to periorm the work for which appllcatl�n la made and I camply with lhe <br /> Slale Contractors Law 18n.27 RC/W an/dJ 298.200 WAC. <br /> ����I�Q� 7 !/r� i�sl�Uli <br /> Signatur ofOwnerlContractor/Aut orizedAgent Dete (/Z <br />