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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE <br /> 3200 CEDAR STREET, EVERETT, WA 98201 O /� <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.or �I��%� <br /> APPLICAT�7NS ARE ACCEPTED FROM 8 AM TO 4 PM " <br /> SITEADDRESS W�`Y �"^t�r' irc�7FunirvicD pqRCELTA%I.D.p ��RM��/ OO <br /> 0�3 �i C S�NJ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY/ZIP PHONE <br /> F�OL lN<� - <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ���iNh YUKI _ff�sNi�tor� 9ZS- 9i� - i�9� <br /> CiA YhIf•IRINJ PaMik'u[71Jd io�r0.ie/�/ /j�R /L'�'�,4N s�p�� SCA7Rt 1(✓AIP PHONE C <br /> i � ZJI�-��Z- I/l1� <br /> CONTR.LICENSE p <br /> fiAKyMCt iS��M�✓ ' - I - U��_ 9�'l0 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���LLCci ,ANJ �"�Ai N�IS�LlO�ITC�' �/ 3�, JJJ <br /> _[lociric _Gas_Olher <br /> WORK DESCRIPTION � -ku�k � � ''�'k�iri ��7"��� <br /> j'RJ✓rAt Si�X(r U� CONC�'cR >>9�� ;>cus S-o i � PP[ S5, /� � Cur2�yni >, /• <br /> �IGHn�Ii f1N� SNCD CANJI��• \ � � � <br /> ��i.� - 'J a OLC CQh2 cLSOK C.. 'J n�tS . D�i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilcl __ A,'C-. r hanAlin9 unils <br /> Ba1hWb __ ForceA.+ stems <br /> Lavalory �w,�sh basin� _ Gas pipinc7 � ��/ �� �� <br /> Shower ___ Walerhealer <br /> Kilchen sink 8 disposal __ Gas lireplace � I L <br /> -- Dichwashor __ Gasranyc Y�Q!'.(� 70 J�� <br /> Clothos washer _ Clothes Aryer <br /> Watcr healcr __ Rangc hood I � �. '}'�� �i�L�l�- <br /> Sink(service/badmo���etc.) _ Ezhausl fan 1 <br /> Dackllowprevenler _ Healpump C�� I-{, <br /> Urinal _ Unit heal�r <br /> Drinking Fountain ____ Boiler L V � <br /> -- Floor drain __ Refrigeration �Fll��1(�i I I `�r� . <br /> Groase Irap __ Woodstovo 1 � <br /> Rool dralns ___ Othor <br /> Other_------- — — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> I hcreby coritify ihat I have roaA and c:xamined this applir.ation and know ihe same to be true and correct. All provisions of laws and <br /> ordinar,es yoveming this type ol work will be complied c�dh whother spoci�ied heroin or not.The gran�ing ol a permil does not prosume <br /> lo c�ive aulhorily lo violate or canr,ol iho pmvision ot any olher slalo or lowl law regulaling conslruction or Iho performance ol <br /> r.onstruction. That I am authorized hy Ihe owner of lhis pruperly to perlonn the work lor which application is made and I comply wilh lhe <br /> Sla�r, Conlrac�ors Law 1 t3.27 RCW and 29f 200 WAC. <br /> C, ti�� ��f(.S�Z<!/.L,�� �.JA�✓��' <br /> I Si Wre ol Own�rlConlrar.lodAiAhorized A9eN Date <br /> I . ---- -_ ___. . - --------' <br /> __ <br />