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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.everettwa.org <br /> �/��L APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � '��� <br /> / -� <br /> SITEADDRESS �dE�%� PARCELTAXI.D.N P MIT• <br /> L �n��i -�— oov � �7// - 3 Z <br /> LEGA LOT NO. BLOCK 7RACT OR SUBDIVISION R � � <br /> DESC. - LO � 2Z� �VE�// St>L�l�/V/S/ON O <br /> OWNER ADDRESS CITY2IP PHQNE <br /> ( �bb)S�f.S�d���/ <br /> �A✓E/✓ C J NC-'rs �.SRuc:T�o.t� /S/� /1�.=�S�i� ScA%/(fG�i4 gg/03 <br /> TENANT NAME I CONTACT FOR PERMR PHONE 4�S- �S� ��Z �J <br /> I P'li2'k'�..�'n�� i-k":��c,N � rvi(,fc��,i ��'� �'-'„��� �-.. <br /> '�c�..�. t'e'a E-MAIL t4lkri�+�<.. l , Lo+� <br /> ,4v�N iN �n�� S Cr.v��'�v�niw� �.Si i �� yS�S� �=AAlE�03 �c�SYS-zd y <br /> CONTR.LICENSE M <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /� _ � _Elnctric �as /� Othor <br /> /1 <br /> 1hDRK DESCRfPTION ]3 AS � C- #O� <br /> � � � IT ( �p - � <br /> � <br /> �-- PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> Toilet A/C-air handling units <br /> � Bathtub Forced air syslems <br /> � Lavalory(wash basin) � Gas piping <br /> Shower Waler heater <br /> � Kilchen sink 8 disposal Z Gas fireplace <br /> Dishwashor Gas range <br /> Cbthes washor � Clalhes dryor <br /> Waler liealer Range hood <br /> Sink (service/bar/moplolc.) � Exhausl fan <br /> Backtlow pravuntor _ Heat pump <br /> Urinal Uni1 heater <br /> _ Drinking Fountain Boiler <br /> _ Floor draln � RofrigerdUon <br /> Grease lrep _ Woodslave <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS]105 <br /> I hereby ceritlly that I havo road and examined this applicaUon and know Iho same to be Wo and cortecl. All provisions af laws anA <br /> ordinacos goveming lhis lype of work will be complied wilh whelhnr specilied hareln or not.The granling ot a permil does not presume <br /> lo give aulhorily lo violata or cancol lhe provision ol any other stale or bcal law regulatlng constructbn or lhe peAortnance of <br /> construclion. That I am aulhorizeC by iho ownnr ol this property lo peAorm Ihe work lor which application Is made and I mmply wilh Ihe <br /> Slale CoNraclors La 18.27 RCW and 296.200 WAC. � <br /> �_,�L� �1��7- �7 <br /> ii'Sig a uro of wnedConUactor Agont Date �/ <br /> 1 Z <br />