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�v -� -c�7 <br /> P�RMIT APPLICATI�I <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 /> APPLICATIO*lS ARE ACCEPTED FROM 8 AM TO 4 PM 3,��,�� _oZ� <br /> SITE ADDRESS PARCEL TAX I.D.p I PERMIT q <br /> 2 � tnsf �'A>��a /`�d =—Z:� IG ��'I <br /> LEGAL lOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. __ <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �J N N l v.H., b c�r� y Z� � �!cas.•:vu r�' �.nn..c� <br /> TENANT NAME CONTACT FOR PERMIT PNONE ,tz�_��r��jy <br /> I�UI-.1N C(/ir"l' 4'^ I'�Z/II-� �'�--K- E�MAIL <br /> Z`bAT�IiZ`�6t�— UR . � <br /> CGNTR.LICENSE N <br /> STAc%.RX e L'zo S <br /> USE OF BUILDING � — HEAT SOURCE —CONTRACT PRICE OF WORK <br /> Eleciric Gas Other <br /> WORK DESCRIPTION <br /> '1-tt'7�i �Zzi-+^� 'M1�c «��'��.etniv-- • <br /> — PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> �Y Tuilet _ lVC-air handling unils <br /> �alhtub _ Forced air syslems <br /> i Lavatory (wash basin) _ Gas pipiny <br /> -- Shower _ Water healer <br /> � Kild�en sink 8 disposal ___ Gas lireplaco <br /> Dishwasher _ Gas ranc�o <br /> Clothes washor _ Clolhes dryer <br /> •L Wa�er heater _ Rango hood <br /> Sink(service/barlmop/elc.) _ Ezhausl fan <br /> Backllow preventer _ Heal pump <br /> � Urinal __ Unit heater <br /> Drinking Fountain _ Boiler <br /> i Floor drain _ Re(rigeralion <br /> --- Greas�Irap __ Woodslove <br /> Roo(drains __ Other <br /> Olhar ��� -- -- <br /> _�� 11_fY{.n��1k2'\L-- — -- <br /> CITY OF EVEREtt LOCAL SA;.ES TAX CODE IS�105 <br /> I hmoby coritily that I have read and azammeA Ihis application and know lho same lo be lrue and correct. All provisions ol laws and <br /> ordinaces�overning Ihis type ol work will be complied wilh whe�her spocified horein or noL The granting ol a permil does not presume <br /> to give aulhurity lo violate or cancel�he provision ol any olher stale or local law regulaling conslruction or ihe padormance of <br /> ccnsiruclion.Thal I am authorized by lhe owner of this proporty to per(orm the work lor which applicalion Is made and I comply with tho <br /> State Corlfraclo aw iB.27 R and 29G.200 WAC. <br /> �-�7�� ,��3+-�-�'_ l�! ' / ��— <br /> Signaluro o�NnodCoNracbr/Authonzed Agent Date <br />