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ERMIT 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 /> I / /,� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM ��J ,1��,�-Q�� <br /> SITE ADDRESS S�^ PARCEL TAX I.D.M �ERMIii,' <br /> 3/l - Z l -� :���"�r U5�3�: �<5'/O/ 7ob � �7 O��o? p// <br /> LE�i4L LOT NO. BIACK TRACT OR SUBD VISIC'N p <br /> IoE.,�. �ars i�d IS �r/ �,- �c.�: ��b�non� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Ku�sex� 1��z7/F.S �/s', ,,�- a`zvo�;��(9�19°�is--25'9-s��7 <br /> TENANT NAME CONTACT F`OR P[RMIT PHONE t�ys-.L�J9_ s-�/O 7 <br /> �OI�C �f7� /JG�d�T' i'ii E-MAIL <br /> ���i(�Nl.�� I <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �E3 /?jC-�1"'/�'` �Eleclric _Gas_Olher � <br /> WORK OESCRIPTION . I <br /> ���57k'uC� SlI1�� �ypt (y �/jy1�'� <br /> I <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> 2 Toilcl A/C-air handling unite <br /> i Ba1M�h 1 Forced air systems <br /> �. Lavalory(wash basin) Gas piping <br /> Shower .L, Wator hoa�er <br /> �__ Kilchon sink 8 disposal Gas fireplace <br /> � Dishwasher Gas ran�o <br /> _i_ Clolhes washer �_ Clo�hes dryer <br /> �_ Waler hoaler _�_ Range hood <br /> Sink(sorvicelbadmop/c�c.) _� Exhaust lan <br /> ` Backllow prevenlor Heat pump <br /> Urinal Unit heater <br /> Drinking Fou��dain Boiler <br /> Floor drain Relriperation <br /> Greaso Irap Woodslove <br /> Rool drains O�her <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I hereby cerilify thal I havo read and examined U�is application and know Ihe same to be lrua and correct. All provisions of laws and <br /> ordinaces�oveming this rype ol work will be complied wilh whether speciliod herein oi noL The granting ol a permit does not Fresume <br /> tn give aulhorily to violate or cancel Ihe provision of any olher state or local law regulaLng construction or tho poAormance ol <br /> construclion. That I am�uthorized by lh wner of this properly lo perlorm thr,work(or which applicalion is mado and I comply wilh tho <br /> Stalc Conlraclor RCVJ a 296200 W�C. <br /> � � !l t0o� <br /> Sign ure ol � ulhorized Agenl Date �/ <br /> Z <br /> �___--- _ _---- — --- --- -- <br />