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i i <br /> RERMIT APPLICATION <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 B AM TO 4 PM <br /> SITE ADDRESS ��PARCEL TAX I.D.N `5.�Z) p�RMIT p <br /> � � r1 s� c �.,L ��,��!�r S Y :f c:� . . c � ,`�: /S �� -� _� 1h <br /> � I� I�.. !J c t ;t Ct c �� ia V CS'��� .�/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITV/ZIP PHONE 4.2� 1��3,�;� <br /> A � M Aksq� 52i�} iuy ��, Si 5 �,1 M� K ��� C-t i.,Ati,� i�r <br /> TENANTNAME CONTACTFORPERMR PHONE <br /> is�nM� � ceN�r_ � ��, Ev��.r �� I A M AK�>,a �� y-z-r � S� ��33� <br /> CONTRACTOR J ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M 'v I � <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> VJo�ili� �� � I��S� �IAN'i� � --���7 ; <br /> �Elociric �Gas_Other > �–� <br /> WORK DESCRIPTION <br /> �''� � � N A � n � n �� u +� � �,� �,; � ias � �; : � �:I <br /> i'.,�Fr_ �� ,,�Ay A � nr_ � � N x � z �,-� �� AS �N � (L�� <br /> PLUMBING VIECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYP. iF FI%TURE OR ITEM <br /> Toile� ___ NC–air handling units <br /> Bathtub __ Foroed air cyslems <br /> Lavalory(wash basin) .__ Gas Piping <br /> Shower __ Water heater <br /> Kitchen sink 8 disposnl __ Gas freplace <br /> Dishwasher __ Gas rargo <br /> Cblhes w�sher __ Clolhes dryor <br /> LaunAry hay _ Rnngu hood <br /> Sink(servicelbarlmop/elc.) ___ Exheusl�an <br /> 6ackflow p�eventer __ Heal pump <br /> Urinal __ Unit haalor <br /> � Drinkinc�Fountain __ Boiler <br /> Floor drain __ Reingorelion <br /> Greaso lrap _ Woodstove <br /> Roof drains ___ Olher ��C 41 <br /> -- Other--- ---- -- �n � f 2 -�.�—. <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritify Ihal I have read and axamined Uiis application and know the same lo be Irue and corroct. All provisions ol laws a.id <br /> ordinaces governing Ihis lype ol work will be complied with whnlher spenGed herein or not.The granting of a permil does not presume <br /> lo�ivu aulhority W violate or cnncel Ihe provision ol any olher state or local law regulaling construdion or the perlormance of <br /> conslruclion. Thal I a i aulhorized by Iho o ier ol this property to poAurm the work for whlch appliration is made end I comply with the <br /> Slale Contr��tors L 7827 RCW and 29 00 WAC. <br /> � � + C <br /> Signatura ol Own r ut rized�gent e� �-� f <br /> ✓ <br />