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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 4'S-257-8857—www.everettwa.org <br /> AQPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AD RESS p PARCEL TAX I.D.p Pc IT# <br /> � / � Cc�a- sT Q�SI d N'7aZ i ao 0 - � <br /> IEGA LOTNO. BLOCN TRACT <br /> DESC. �/�— � � — <br /> O�MNER ADDRESS CITYIZIP , PHONE <br /> k����/ �-��i2�,��-��t��„�� z i�� �.,�, si r_�'v�,���- Za� a �6� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTPACTOR ci� Dav�G� ADDRESS '�/ZG ��„� �iST�'n'21P PHONE��27/�?S <br /> /O <br /> CONTR.UCENSE It <br /> USE OF BUILDING /d HENT SOURCE I CONTRACT PP.IC[OF WORK <br /> `'���y� N rl Electric _Gas_,Olhcr <br /> WORK DESCRIPTION <br /> (�/l' �t�.l���:l1 �%G'�C��i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OH ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handlinp units <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Walorhealer <br /> I — Kilchen sink 8 disposal = Gas lireplaco � <br /> Dishwasher Gasrange <br /> � Clolhes washor _ Clo�hes dryer <br /> Wator heater _ Rango hood <br /> Si�k(service/bar/moplotc.� _ Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal _ Unil hoaler <br /> Drinking founlain _ Boiler � <br /> Floordrain _ Refrigeration �5 X�� <br /> Grease Irap _ W�dsto�e <br /> Roof drains _ Olher <br /> Other -- <br /> CITV OF EVtRETT IOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilily Ihat I have read and examined Ihis applicalion and know Ihe same lo be Irue and correcl All provisions ol laws and <br /> ordinaces governing Ihis lypo of work will be complied wilh whelhor specified horoin or nol The granting of a permit does no�presume I <br /> lo give aulhorily to viclate or cancel�he pmvision o(any olher sla�e or bcal law rogulaling wnslnu�ion or lhe pedormance nf <br /> r.onstruclion. Tha� I �m authorized by Ihe ownor o(lhis properly to peRorm�he work(or which ap�>�Ication is made and I comply wilh lhe <br /> Slatc Conl s La�y .27 and 296.200 WAC. <br /> ��� � �lC7 " � �� / <br /> �����z� � . - <br /> Siynalure of OwnedCo t ,orlAuthorized Agent Dale �/i <br />