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i <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.evereltwa.org <br /> ��3/� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � —��l/� _ <br /> C <br /> SITE ADDRESS �lPT PARCEL TAl(I.D.N P�M��/ _ � <br /> �- �/✓C� / '�/� o�y � <br /> LEGA LOT NO. BLOCK TRACT OR SU801VISION f <br /> DESC. _ ZD � .2 2 � EVE�// Sv�7/ViS�DN 'O � � <br /> OWNER ADDRESS CITV2IP PHqN�G1�s'aV�y <br /> n n� , C / <br /> /C fl�/Ei✓ � �N�S �/SR�J�i��� /S/i � �?St-fi� Srf/%/(fl.vi4 gR/�3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE q 2.5 c S � 12 ���� <br /> ��r����, i�, �.����.�,, �mpr.••-r...� ,. ���:, � � <br /> ''r�tmm �' �'�\ E-MAIL �Ie-� �ti ��. I .�0, <br /> �v��v � �n,� s Ctv�si/z��.r��+a.� i S�i �� � ss�hs i �An/��'s+o3 �nc)sYs-za y <br /> CONTR.LICENSE� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /� _ � _Electric �as /� Other <br /> /1 <br /> WDRKt1E:CRIPTION '�� ( '� Q � � <br /> v __I I Z - � •- <br /> �D PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tollet _ A/C-air handHng unils <br /> � Balhlub Forced alr syslems <br /> Lavalary(wash basin) � Gas piping <br /> � Shower ,_ Waterhealer <br /> Kilchen sink E disposal �_ Gas fireplace <br /> � Dishwasher Gasrange <br /> / Clolhes washer � Clolhes dryer <br /> � Waler hoater � Renge hood <br /> Sink(service/bar/mop/atc.) � Exhausl(an <br /> BackOow preventer _ Heatpump <br /> Urinal _ Unfl healer <br /> _ Drinking fountain Bolle� <br /> Floor draln � RoMgeralian <br /> Greasetrap _ Woodslove <br /> Roo(drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilily Ihal I have read and oxamined this applicalion and know Ihe same to be true and wrrect. All piovisions of laws and <br /> ordinaces governing Ihis lype o(work will be comptied wilh whelher specified herein or rwt The granling ot a pertnit does not presume <br /> to give authorily lo vialale or cancol lho provision ol any other stale or local law reguladng consWctlon or Ihe pertortnance ol <br /> conslruction.That I am authorizod by Ihu owner ol lhis property lo peAortn tho work for which appllcaUon Is made and I comply wilh Ihe <br /> S��nlraclors Le 18.27 RCW and 296.200 WAC. <br /> ��'o`�. 07 / <br /> i Sig a ure of wner/Contraclor Agenl Dale �L <br />