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�rRMIT APPLICATIC�N <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AODRESS � PARCEL TAl(I.D.N PERMIT N <br /> �,o W. ����N� �,� _ �D07- Y�SLv <br /> LEGA LOT N0. BLOCK TRACT OR 6UBDIVISION N <br /> DESC. <br /> OWNER AODREBS CITY2IP PHONE <br /> ������ <br /> TENANT NAME CO TACT FOH PERMIT '/��N�.,G_ 2.S�y <br /> / <br /> /� ��:!'��' S1J��'1✓�4'�S�' 1 �f e.MN� <br /> � pQF R-n/ 13L_DC 5�/5�--�brt� <br /> CON1R.LICEN9E M <br /> USE OF BUILDI HEAT SOURCE I CONTRACT PRICE OF WORK <br /> U i,F��E �R,c-�b K 2o��p I _Eleclric _Gas_Other .�'t�—' <br /> WORK DESCRIPTION �.¢� 7�2 ^ <br /> /,ti'S 1 T ll,A /LLP- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel _ AIC—air handling unils <br /> Bathtub _ Forced alr syslems <br /> lavatory(wasl�basin) _ Gas piping <br /> Shower _ Weterhealer <br /> Kilchen slnk 8 disposal _ Ges fireplace <br /> Dishwasher ,_ Gas renge <br /> Clothes washer ._ Clolhes dryer <br /> Waler healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhauslfan <br /> Backtlow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Founlaln _ Boiler <br /> �loor draln _ Relrlperetion <br /> Grease lrap _ W�dslove <br /> Roo(dralns _ Olher <br /> Other — <br /> CITV OP EVERETT LOCAL BALES TAX CODE 19 3105 <br /> I hereby cerilify thal I have read end ezamined ihis applicaUon end know lhe same to be lrue and cortect. All provisions of lews and <br /> ordinaces goveming this lype ot work will be complied wilh whether specilied hereln or nol.The grantinp of a permit doea nol presume <br /> to give aulhorily lo violale or cancel the provision ot any olher slate or local law repulating conslruction or the per(ortnance o( <br /> conslruclion.Thel I a autho�ized by lhe owner o1 this propeAy lo peAortn the work lor whlch applica4on Is mede end I oomply with the i <br /> Slal ontraclors L 1 27 C and 296.200 WAC. <br /> �.�-�-� ���' 7lz-��i�+ <br /> algnature ot Ow�erlConlractorlAuthonzed Agenl Date f, <br /> � <br />