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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 /> �/1r'i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � "��D� <br /> J <br /> SITE ADDRESS ��� PARCEL TAX I.D.N PERMIT N <br /> - c Esrn��i-�-r= oov � C - ' <br /> LEGA LOT N0. OLOCK TRACT OR SUBDIVISION M <br /> DESC. - LO � 22 � EVE�%/ SJ�7iViS�DN 'O � � <br /> OWNER ADDRESS CITYIZIP PM�N����S,a��y <br /> �A��n/ �i��vGS �/S2vcT�o,J isi� /lI ?Sf'h� SEA%/lfl.vAqg/�3 <br /> TENANT NAME CONTACT FnR PER PHONE �C• L SZ-r'1 Za� <br /> �,��p2Ess�o,., �E��c�w �m�i�ssw... d�-�9nF h,.-n,o; �, <br /> �— ?qr+�n•-r (eFN E�MIUL CuM <br /> �iv�N Gv �n�G S C:tv��'.v�!TitrU � S�� i� . SS�S� �Alll6`/Ts���i ]1�6)5'I S -z01 y <br /> CONTR.LICENSE k <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� _ � _Eloctric �as /� Other <br /> WORN DESCRIPTION� <br /> �iN�f � 11 (����.s�c. 3oCo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handlin; unils <br /> F� Bathtub Forcad air systoms <br /> � Lavalory(wash basin) � Gas piping <br /> Showor Waler hoater <br /> / Kitchon sink&disposal � Gas liroplaco <br /> � Dishwasher Gas rango <br /> / Clolhos washer T Clolhes dryor <br /> Watar hoator Ranc�o hood <br /> Sink(sorvico/badmop/otc.) � Exhausl fan <br /> BackOow provenler _ Hoal pump <br /> Urinal _ Unil hoator <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigcralion <br /> Groaso trap _ Woodslovo <br /> Roof drains _ Olhor <br /> Other _ — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 �. <br /> I hereby cerili(y that I have road and ezamined this applicalion and know tha samo lo be truo and correcl. Atl provisions of laws and I <br /> ordinaces goveming Ihis type of work will bo complicd with whethor spociliod herein or not.Tho gra�ling ol a permlt does not prosumo . <br /> to pivo aulhority lo aiolali�or cancel Ihe provision of any other stale or local law roc�ulating consWclion or tho performance of ��, <br /> conslruclion.Thal 1 am authorized by Ihe ownor of this pmperty lo por(orm Iho work for which application is mado and I comply wilh Ihe <br /> S��Nraclors La tt1.27 RCW an'29�.200 WAC. <br /> /i-n7_ D7 <br /> i�5i{� a ure ol wnedContraclor Agont Dato <br /> ' Iz <br />