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� cRMIT APPLICATI'vN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 4F� �-(.�PI,JE b� I S��o fi o I - G9D <br /> LEGAL LOT N0. BLOCK TRACT OR SUBUIVISION# <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONELD� �' � � <br /> uD�lE� � h'�AEi,¢ �EI,J�K! ZIDLD S�,(r�+rtiT C�l FD�o�DS, `I�JZ(c C � N�(�G <br /> TENANT NAME CONTACT FOR PERMIT PHON�ytf p-1O' T.�Q`� <br /> �LL���,� LCh/I j I /�"�T' ��^� E-neaL�G�11�TdJ• �nMAl,C.oM <br /> '7ib6AE�S �IT9/LTD-PAaN� <br /> / <br /> CONTR.LICENSE k I J(_V�C,.,ti-}- �,J ���T <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> SF R �Electric _Gas_Other <br /> WORK DESCRIVTION <br /> c:o�v��r �x�sn.✓6, c�4P�l�r i.✓ra c,�-RA�� <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toil�t _ A/C-air handling unils <br /> Bathtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Walor hoaler <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> �ishwashor _ Gasrange <br /> Clolhos washer _ Clolhes dryer <br /> Waler hoaler _ Range hood <br /> Sink(service/badmop/o1c.) _ Exhaust fan <br /> Backllow preventor _ Heal pump <br /> Urinal __ Unil heatar <br /> Drinking Fountain Boiler <br /> Floor drain _ Refrigeration <br /> Groaso Irap _ Woodslovo <br /> Roof drains _ Other <br /> Olhar — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 7705 <br /> I hereby curitify lhal I havo read and oxamined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinacos governing this lypo of work wili be compliod with whether spaciliod herein or noL Tho granling of a permit does not presume <br /> to give authoriry lo violato or cancot tha provision o(any olher slate or local law regulaling cunsWctlon or lhe performance o( <br /> conslruclion.Thal I am authorized by Ihe ownor of this property to perform Ihe work for which applica:ion is made and I comply wilh lhe <br /> Stato CoNrad s u1r . 7 R 5200 WAC. <br /> �.— , . �_ �%,-� - 1-��'- c o �/ <br /> i�nat o wnedContre r uthonzed Agent Dato � <br /> L <br />