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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8B10-FAX 425-257-8857-www.everettwa.org <br /> ����� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �` b '�� <br /> SITE ADDRESS C�T PARCEL TAX I.O.A PERMIT/ <br /> c �n��T � ooy ��ni �� � C' 7/r Zn <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION� � � <br /> oesc. _ Z� � 22� EVE�/!SUg7�viSioti 'O <br /> OWNER AODRESS CITYIZIP PH�"��sys-a��y <br /> �i9��n/ ����vc�s �A�/SK✓�T��� isi� � ssEl,�: SE���CFu�A9ein3 -- <br /> TENANTNAME_ I CONTACT FOR PERMIT PHONE 4 1S'7S'z - �I Z`-"� <br /> 1�p:r�:,�u', ���"���,r- 1 y\ � .� �, <br /> . rr �:;, ,u�.-It±•;.� <br /> ��[1�r��4, k i����� EdYIAIL I�i.s�r.e„( .C.� <br /> ,fv�ni :%��n�� S Cavv�i�even�r✓ �S�I �� • SS"�S� �AnlE�03 �)svs-Za y <br /> CONTR.LICENSE II <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /� _ � _Elecldc �ias /� Olhor <br /> /1 <br /> WqRKDE3CRIPTION '�5 (C, � � � <br /> l� /J I I �� '� 8 <br /> , ` <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF F�X7URE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> Tollel A/C-alr hendling unils <br /> � Bathtub Forced air syslems <br /> Lavalory(wash basin) � Gas piping <br /> � Shower Walor heator <br /> Kilchon sink 8 disposal = Gas fireplace <br /> �- Dishwashar Gas range <br /> % Clolhes washer % Clothes dryor <br /> � Water haater � Range hood <br /> _ Sink(service/bar/mop/atc.) � Ezhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil healet <br /> Drinking Founlain Boiler <br /> _ Floor drain � RO��A°��10^ <br /> Grease Irap — WO0dS1OVB <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 7105 <br /> I heraby corility Ihal I have read and examined this applicallon and know Ihe sama to be true and cortecl. All provisfons of laws and <br /> ordinaces govorning lhis lype o(work will be complled wilh whether apecified herein or noL The grantlng ol a permlt does nol presume <br /> to give authority lo violate or cancel lhe prov(sion of any olher slalo or bcal law regulaUng cronstruclbn or Ihe peAormence ol <br /> construclian.Thal I am authorized by the owner of this propeAy to perfortn the work lor wh.cli applicatlon Is made and I comply with Ihe <br /> "tate Contractors La 70.27 RCW and 288.200 WAC. <br /> � ,._ � /%-07_ 07 <br /> i'Sig a ure ol nedContrac or d Agent Date <br /> ��Z <br />