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l � <br /> PtRMIT APPLICATIdN <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 0 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAl(I.D.N PERMIT/ <br /> o n� — ,�E M �Svq-ooz <br /> LEGA LO7N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE89 CITY2IP <br /> yda.i <br /> �,�o`��u Q� I D�So A� loD� ,�,Uq�e �A-�E �Utrtt`f 'fu�2s i - 9a's 6 <br /> TENANT NAME I CONTACT FOR R�MIT PHONE <br /> I�f�(� �t)c�ol 7Ns�a IIAI`� o NS _����/� <br /> CONTRACTOR ADDRE83 CITYfLIP OMONE <br /> :ONTR.LICENBE M � <br /> yzs= 7ys sq� z <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas Olher <br /> WORK OESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUfTURE OR ITEM <br /> � Toilet A1C—alr hendling units <br /> Bathtub Forced alr systems <br /> _ Lavalary(wash basin) Gas piping <br /> _ Shower � Walerheater <br /> Kitchen slnk 8 disposal ,� Gas(Ireplace <br /> Dishwashor Gasrange <br /> Clolhes washer Clothes dryer <br /> Laundry tray Rango hood <br /> Sink(service/bar/moplelc.) Exhaust fan <br /> Backtlow prevenler Heal pump <br /> Unnal UNtheater <br /> Drinking Fountain Boller <br /> � Floor drain Refrigeration <br /> Greaso trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAI(CODE IS J10S <br /> I hereby ceritify Ihat I have read and examined Ihis app�ication and know the same lo be true and correcl. All provlsions of lawa and <br /> ordinaces governing this lype of work will bs complied with whelher epecmed herein or not.The granling of a pertnit does nol presume <br /> to give authoriry lo viotate or cancel the provlsion of any other state or local law regulatlng canstructlon or lhe peAortnance of <br /> construction.That I am aulhorized by the owner of this property to pertorm the work for which appllcaUon Is made and 1 comply with the <br /> Contractors L 827 RCW and 298.200 WAC. <br /> -G -OS� <br /> ignature o Ow r/ onUaclorlA hadzed Agent Dete <br />