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� <br /> FcRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8:.10—FAX 425-257•8857—www,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM -pEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.p.# P MIT N <br /> 'r 3 / �,4z�E�� oo � �4�oozvz tioo ���/-03 <br /> LEGA LOTNO. BLOCK TRACT <br /> IDESC. Z �� Z />�.�t-�ey L'�l'�.a.�.4...nS ✓�iv I <br /> OWNER ADDRESS CITY2IP PHONE <br /> ' yLj 3S3 S <br /> C�-ICiS s �CIqi� Nr ��CL, !?i! tiq« Cw Evtr�T7- ciy��o3 <br /> TtNANT NAME I CONTACT FOR PERM17 PHONE <br /> �n ��s�.� 42s zs��- � � �i <br /> CONTRACTOR ADDRE35 <br /> �.:)c�FtC � CITY2IP PflONE <br /> CONTR.UCENS M�Aa,t'S /��[ 7�7? (' �E'Jc-rc�� Ai�c" t_VtcFTj- l„q. °iyLci 2sti- � 3�i <br /> I�qC rFE.I Uf�r�J�./ <br /> USE OF BUILDING I HEA7 SOURCE CONTRACT PRICE OF WORK <br /> /vC}'V l? <br /> �-�t) :'G�C-L- I _ElecMc __Gas_Othar /�J�pp <br /> WORK DESCRIP710N <br /> C O�� ST,t.� �i C� �Yic rt�:�� c�LIL'46,t_ <br /> PLUMBING MrCHANICAL <br /> N�• TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tollet A/C-alr handling unita <br /> __ Bathtub Forced�tir syatems ) <br /> I = Lavatory(wash basin) /' = Gas plping � <br /> _ Shower Waterheater j <br /> Kitchen�ink 8 disposal . Gae flreplaca <br /> I = Dishwasher � Ges range <br /> Clothea washer Clothes drynr '� <br /> ! Laundry trey Ranpe hood� <br /> I = Slnk(service/4Admcpletc.j _ Exhauet f <br /> Backflow pre"venter Haev�p <br /> _ Urinal / - Unit eIS ater <br /> � ___ Dnnkln�Fountain — <br /> Floar drain Boiler <br /> � _ ��B�va��P _ Refriperallon <br /> , _ Rootdrains _ O�8 stove <br /> , =I Uthor _ _ <br /> I — <br /> �� CITY OF EVERETf LOCAL SALE9 7AX CODE 19�105 <br /> j i hnreby cerifify fhat I have road and examined this applicaUon and know the eame to be true and corcect. Alt proNsions af laws and <br /> I ordinaces goveming this rypb of wcrk will be complied with whether specifled herein or not The grenting of a perrr�it doea not presume <br /> i to grva authaity to violate or cancel tha provision ot any other state or local law regulaUnp consWcGon or tha peAormance of <br /> cor.structior. That!am authorized by the owner of this property to perform the work for which applicatlon ie made and I comply with the <br /> i Statn Con:rect vL�4,.27f�tCW aw 296.2U0 WAC. <br /> i ,/ <br /> �- iJ( �_i �'�' '�3i/a j <br /> Signeiure o wnerl ontractor/ uthonze gent et"�- � <br /> IL <br />