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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 /> � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��-�—D� <br /> SITE AODRESS � ]� PARCEL TAX I.D.N P RMIT N <br /> -•=�� L c,�n�� i -�- oc.v �� � 7// -z7 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. - LU � .� .ZS� � VC'./�// SL)B/�/6bS�U/U =O � � <br /> OWNER ADDRESS CITY2IP PHONE `� <br /> ' /% ' ( �L[�S`�5".���7 <br /> �i�VG- i✓ �l/ •iv(�S �Ft�/yh✓�T�o.tl /S%i �. ��:�E/i5i. SrA/iLEG�f� n�?ic�.3 <br /> TENANT NAME I CONTACT FOR PE�IT PHONE r}ZS ' Z'7 ' 12 �v <br /> ��y�P�C�»��'-' 1�[3��N lai(',r;.�iu� c,.••,�i��� C.; l..n w.�•� 1. <br /> '"(L�i/v�.� � <Cn E-MAIL C•��h <br /> iqVcN :v � n: i� S �.ul.v'/�V�.'.Tic/L' i .S/l /V '�Sf�IS� �/!A/F i'rS'+O i .�Ll) 5"`JS-2U�y <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> C _ � Eleclric �as /� Olhcr <br /> /1 <br /> N WpRKDESCRIPTION �'AS I C- <br /> l�Kl � ���� � .30(c� <br /> ' ' A <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%tURE OR ITEM <br /> Toilet A/C-air handiinp unfls <br /> m_ �alhlub Forced alr systems <br /> � Lava�ory(wash basin) Gas piping <br /> Showar Water healor <br /> / Kilchon sink 8 disposal Gas lireplaco <br /> % Dishwashar Gasrango <br /> Cbthes washer � Clothes dryor <br /> Walar hoator Range hood <br /> Sink(servicoNadmoplatc.) � Ezhaust(an <br /> BackOow proveNcr Hcat pump <br /> Urinal Unll hoatar <br /> _ Drinkinp Fountain Boitor <br /> _ Floor drain � Relrigeration <br /> Greaso lrap Woodslovo <br /> Roof diains Olhar <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I heroby coritify thal l havo read and ezamined lhis application and know tho samo lo be lrue and correcl. All provisions of laws and <br /> ordinaces govorning Ihis lypo of work will be comptied wilh wholhor specified horein or nol.Tho qranting of a permit does nol presume <br /> lo{�iva authorily lo violate or cancel Iho provision of any other slalo or local law regulaling construclion or Ihe parformance ol <br /> conslruclion. Thal I am authorized by tho ownar ol lhis property to peAorm lha work lor which application fs made and I comply wilh Ihe <br /> Slale CoNraclors La 1827 RCW and 296.200 WAC. <br /> �._,', ,-i � ���n`�. U7 <br /> i�Sig a urc ol wner/Conlraclor �eed Agen� Dalo I/ <br /> � <br />