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- t - --- - - --� - - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?01 <br /> 425-257-8610-FAX 425-257-6857-www.evereltwa org <br /> APPLICATIONS ARE ACCEPTED FROM R AM TO 4 PM � _...) �—�Q <br /> SITE ADDRESS. PARCEL TAX I.D.ri PERMIT N <br /> �7� C: �,I� ,4��,.,�� �. �lcxia -c��3 <br /> LEGA LOT NO. BIOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNEH I ADDRESE CITYIZR PMONE <br /> ��c,J �-(�-MMc�1' Y2.s- i�7-733� <br /> TENANT NAME 1 CONTACT FOR PERMIT PHONE _3F G ' 7(N-HU� L <br /> �' ('GfG.•1t.C- (�'`W\u— -i�r'C.. I Er �/\� N W(��50 � Ea11A�LcJ;�.�r`i12r=iitcJ.� ti <br /> $ <br /> CONTR.LICENSE M '� <br /> � r <br /> �z: •!,..,,J-i l�) i<'�!-1ti �-�� /�t i?Cv4`Ttr <br /> USE OF BUILDING � HEAT SOIIRCE CONTRACT PRICE OF WORK <br /> J`��/ �w�;_ u � 5��, I _ElCdric 1�(�ies_O�het /Q G O o �r LN y s <br /> � <br /> WORK DESCR�PTION 1 � � (� S � �_� ' � ��> <br /> � ��.�.1'... L�- � .�ru 7�G•�i.) . � <br /> PLUMBING MECHANICAL <br /> NO. tYPE OF FIN7URE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilel NC–air bandhng un�ts <br /> Batbtub � _ Forced air syslems <br /> Lavalory(wasl�basin) _ Gas piping <br /> � ShOwer . Wa�er h0ater <br /> _ Kilcben sink 8 disposal - Gas fireplace � <br /> Dishwasher Gae range <br /> Clolhes washer � Ctolhes dryer i� <br /> Woie�hoolei .' ��p RUngc hOOd <br /> _� $ink(service;bar/mOp7elc) ��" 1 _ Exhausl fen <br /> _ �ock0ow prevenler � �V 1�C C __ Heol pump <br /> U�inal \'� •�I�� __ Unil hPAler I <br /> _ Dr�nkingpounlain . Q ^ ^ ��1� __ Boiler I <br /> _ Floor drein lj��4 I �/� Refrigeialion <br /> _ GreeseUop ����; — Woodalove ,� <br /> Rool drains Olher <br /> _ Olher_�_ ' _ <br /> i �— <br /> / <br /> CIT/OF EVERETT LOCAL SALES TAX W�E IS J10fi <br /> I heicby cedily Ihal I have mad and examined Ihis appliralion end kno�v Ihe semr to be liu�end coneci All piowsions of laws and <br /> ordinances goveming Ihis typo ol work will be comphed wnth whether specified herein or nol.Tha granlina of a permil doos ool proaume <br /> In c�ive authcrily lo violale or cencet Ihe piovision ol any other s!ale a iocal law iepulatirg conslruction ur Ihe pertoimance of <br /> construction. Thal l am authonzed by Ihe owner of lhis properfy lo peAorm Ihe worh for which opplication is mode end 1 comply vntb Ihe <br /> Slate Comractors:aw�17�RCW and 2962qdV�7+C. <br /> ;S ���.-`� � �`�� OL-ll-ro <br /> Signalure ol Owner/Contraclor/Aulhonzed Agent Date / <br /> i <br /> 2 <br />