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4 <br /> PERMIT �4PPL��ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��'"I �F7 I <br /> SITE��� SS � � ^ � � A � PARCELTAX�.p y� �y� PERMI�A <br /> � j�j/ Hj L�l�-W <br /> ` i/ , • /� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �i7'��'t1lV!!"�/1 �` ��i �Z9 �ll� ��GD �"�`�'ZU� <br /> TENANT NAME . � C TACT FO PERu�IT • � PHONE f��2 � <br /> �lf���'K//�i�' lnG�� ' '(� �frN ,�r n 11 S e�a�.af�c7rN ' / �rfn .[e�1 <br /> � �v� �,o�� ��, . <br /> CONTR.UCENSE N //1� I�'/�/_ ���� �I /� ��7.,/ C�T/�7�/((f���7 <br /> v�t� i�T 'I/ !�u <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WOHK <br /> /��/� _Eleciric �Gas_Olher � �/Gl�,����� <br /> / <br /> WORK DESCRIPTIO <br /> CCa1��1�L''v�'?G3�I � .'I I�J`✓' `� ��' Gl/?'� �/d1�I r, �I�'I'Il I/I �IC1 <br /> E�f�a�(/lli�'l �'{Jf��1✓1 <br /> PLUMBI MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPIi OF FlXTURE OR 15EM <br /> _ Toilel A/C—air handling units <br /> _ Balhtub Forcedairsyslems <br /> _ Lavatory(wash basin� Gas piping <br /> Shower 1Nater heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> _ Backtlow praventer Heat pump <br /> _ Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Refrigeralion <br /> _ Grease�rap Woodstove <br /> Roof drains Cdher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE 5 7105 <br /> I hereby ceritify�hal I have read and examined this application and know the same!o be true and conect. Ail provisians of laws and <br /> ordinaces govQrning this type of work will be complied with whelher specified herein or not.The granting ol a permit dces not presume <br /> to give aul it to violate or cancel Ihe provision of any olher stale or local law regu�ating conslruction or the performance ol <br /> constructi n. }1 am autliorized by th owner of Ihis property to perlorm the work lor which app�ication is made and I�mply with the <br /> State Co ors .27 d 2 6200 WAC. <br /> � � <br /> ignature ol Owner/ContractorlAuthorized Agent Date <br /> _ ( yz <br />