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PERIV�IT APPLICATION <br /> CITY OF EVL=RETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FNC 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM 3-vg--�7 <br /> SITE ADDRESS W A �Qi-�-O y- PARCEL TA7(I.h.6 P��70� .OOS <br /> 51 U l�J Q_= ' _ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE �_3 -15�� <br /> l3a�bir- sin9��_�01 P�nnee� Nu�y �,st A�-I;r�Stur�,u1F49f�.z.Zs' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I c h�n NwaM '�) 4i5-�45-�4�-5 -���X�4i5J'/4S-c425 <br /> ' G�-- ��)4�-S�-68-3890 E-Ma;I� Cr�uk�m31�T�JYuh« co�,� <br /> CONTRAC70R ' ADDRESS CIN21P PHONE <br /> ��'UJ���,� l�e.�c, Ir�vterQ�r;lr�t�1� i. � ua, .it5 ��� 3� q� <br /> i� <br /> CONTR.LICENSE p / <br /> i� �M�'�3 ' .('P�� �l' �'' c'-�Pi'2� <br /> USE OF BUILDING �� HE T SOURCE CONTRACT FFtCS OF WUHK <br /> ��0$'f <br /> _Eloc:tric _Gas_Olher ` t��7'lll �� <br /> �S1— <br /> WORK D[SCRIPTION <br /> 7 , �. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilet ✓ A/C-air handling units <br /> Balhtub � Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower W atar hoalor <br /> �� Kitchen sink 8 disposal Gas lireplace <br /> shwashor Gas ranga <br /> C the;:washor Clolhes dryer <br /> v Wa r hoater nge h�od <br /> _� Siuk orvic�lbaumoplcic.) E auslian <br /> _ Backflo prevenler Hea ump <br /> Urinal Unit h ter <br /> Drinking F ntain Boiler <br /> ✓ Floor drain Relri6ara�i <br /> v Grease Irap Woodstove <br /> — Roo(drains - =I Olher <br /> Olhor <br /> CITY OF EVEREtt LOCAL SALES TAX CODE IS 3105 <br /> I horoby cerilify ihat I have read and examined this application and know the samo to bo true and correcL AII Nrovisions of laws and <br /> ordinares governin�Ihis typu o' w�rk will 6o compliod wilh who�hor specifi�d horein or nol.The granting of a permil does nol presume <br /> lo�ivo authority to viulate or c;an,�.ul the��iovision of any other stale or loca�law rogulaling consWction or the pedo•manca o( <br /> construction. That I am aulhorizod 6y th�e owner of this propedy to peAorm the work for which epplicalion Is mado a��d I comply with the <br /> Slate Coniradors Law 1927 RCW and '1�JG200 WAC. <br /> , �i <br /> � 1�:,�w..c � ., I 4 0 <br /> Signaturo ol Ownerl�onlr� odAulhorized Agent Date (' <br /> I L <br /> 1 _-- — __._ _ _-- ----- - ----- -- <br />