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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> �/� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM f��g�� <br /> SITE ADDRE35 ��7 PARCEL TAX I.D.N PERMIT/ <br /> c ��� � � ooy :��� -2z <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION� <br /> DESC. - LO � � 2� EVE�// St>�4�/V/S/ON O � � <br /> OWNER ADDRESS CITY2IP PMONE <br /> /�Av�i✓ ����vc�s c ��s�_s-�o�y <br /> �s���T,o,J is�� �J..ss�l,�ScATiLELdA9s3/a3 <br /> TENANT NAME I CONTAC�T FOR PERMIT PHONE ,(.Z S- 2 SZ- �I Z< �-n <br /> �Pll �-E'J.�Ic..� (>l-'.�iC,v�.� �1M��C��cn'1C� �'.� <br /> t'_`.>1�/1 c <br /> rClrxwu . L' � Y� E�A1 L �'L:�Z � . 1 d <br /> �4v�iv N,n,� s c:v��i/�Vu,�N , s,, ,� . ssf�,si �:.s,r�E /�S+J� ?!J�)svs-Zv�y <br /> CONTR.LICENSE JI <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> __� _ � Eloclric �os /� Other <br /> WORK DESCRIPTION � AS I C Q'- <br /> LJ1.7 ll. Co 3oFs <br /> v PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> ��' Toilet A/C-air handlirg unils ' <br /> � �__ Bathtub Forcod air syslems <br /> Lavatory(wash ba:;in) � Gas pipirg <br /> Shawer Waler henler <br /> � Yilchon sfnk d disposal Z Ges flmplace <br /> Dishwashor Gne rango <br /> � Clothes washor ? Clolhes dryor <br /> ,� Waler healor r Ranpe hood <br /> Sink(sarvico/bar/mop/etc.) � Ezhausl fan <br /> Bacl,tl:�w prevontor Heal pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain � RolrigeraUon <br /> Grease trap Woodsluw3 <br /> Root drains Olher <br /> Othar <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> I hereby ceritify that I havo read and examined Ihis appflcaRon and know Ihe same to be We and cortect. All provislons of laws and <br /> ordinacos gaveming Ihis type ol work wlll be complied wilh whether spocilied herein or rrol.The granling of a pertnll does nol prosume <br /> lo give aulhorily lo violale or cancel lhe provlsion of eny ather slale or bcal law regulatlng conslructlon or the performance o( <br /> conslruction.Thal I am aulharized by Ihe owner of this propeAy to porfortn Ihe work lor which appikation is made and I comply with Ihe <br /> Slate Conlraclors la 10.27 RCW and 296.200 WAC. <br /> �,�c�� /�-07_ 07 <br /> i Slg a ure of adConlracto Agent Date ,I2 <br /> � <br />