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r <br /> .. r- t <br /> \ <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVlCES - <br /> 3200 CEDAR STREET, EVER[1T,WA 982)1 <br /> 425-257-8810—FAX 425-257-8857—www.evere�twa.org ' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> / 3�c ev� ,� �a� 6 v �a -o �� <br /> LEGA LOT NO. BLOCK �RA�jT OH SUBDINSION N� �/ <br /> DESC. :�T A �' � /-)S/" D3� D OCJ <br /> OWNER ADDRESS CITYZP PHONE <br /> Q UToZo�-4��t�C i 23 S F1�otitT M�MPI�ts,T►� , 38�3 �t�l -445- 87! <br /> TENANT NAME CONTACT FOR PERMIT PHONE 901 -4�{�j-�TIC�. <br /> IMI��� Ll�� E�IAIL- 1'T�H. Ll <br /> r r�.� � � ,�' <br /> AuT+�zo e ,co�'�t <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��M'M�p�.�q.(_- T:��t�l� I _Eiectric v Gas_Other I <br /> WORKDESCRIPTION CONr�c�GH 0�- � Orl6 �'YD2�{ Yl����� I��L�I �✓�O <br /> �'orz ��tAtl, �u�t2'T� �41.f� u5�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FOCTURE OR ITEM <br /> Toilet � NC-airhandlingunits <br /> � Bathtub - Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> Shov.�sr 1 Waler healer <br /> - `Kitchen sink&disposal � Gas fireplace <br /> Dis�washer Gasrange <br /> T Clothes washer � Ranhe hood r <br /> � Waterfie@ter 9 <br /> � Sink(service/bar/mop/etc.) '� Exhaust fan <br /> � Uanarlowpreven\\ _ Uea1he ep <br /> � Drinking Fountain ��'�\ = Botl <br /> - Floor drain Re(rig ation <br /> Grease trap �� = Woodst e <br /> � Roof drains _ Olher <br /> Other — <br /> _ � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby ceritify thal I have re2d and examined ihis app�icatiun and know the same to be lrue and correct. All provisions ot�aws and <br /> ordinaces governir�g this type of work will be complied with whether specified herein or not.The granting of a permit does nol presume <br /> to pive authority to violate or cancel the provision of any o�her stale or local law regulating consiruction or the performance of <br /> construction.That I am authorized by the owner of this property to peAorm ihe work for which application is made and I comply with the <br /> St te C h tors Law 1827 RC,NI and 296.200 WAC. <br /> /�I <br /> � � L �j n, Y/ 'I�1JT�<-0�V�� I'1-IC� �Z-�-04 <br /> S gnature of O er/ ontracror/Authonzed Agent Date �/ <br /> s� a3aa� z <br />