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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C1 :��--SI—D� <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> 85 o a � So4i3ooioo5foo '1� � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# � <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> F{Lrd V11t �� S�eseS 17,0. 355y� . 7��ISd OK. 75/53 <br /> 7ENANTNAME I CONTACTF RPERMIT PHONE <br /> 3bo • 65r • 7�01 <br /> C l� A s t $A n 1� e�nta� <br /> � SMt+ k F;�e� Sys�l�Ms y�ob f3i7" sl . w• E. <br /> CONTR.UCENSE it <br /> Wla ,.' � 9 7 / 360 • 65� • 7 �0 � <br /> USE OF BUILDING I — HEA SGURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Other d �� �0 � <br /> WORK DESCRIPTION <br /> EY{c�al tYii��n� S � � �sw , I �J' {�eAdS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM I <br /> _ Toilel A/C-air handlirx�units � <br /> Bathlub Forced air systems <br /> I Lavatory(wash basin) Gas piping ' <br /> Shower Walcr hoatcr <br /> Kilchen sink 3 disposal Gas firepiaco � <br /> _ Dishwasher Gas rango � <br /> Clothos washer Cbthos dryer ; <br /> _ Wator hoator _ Ranpa twod � <br /> _ Sink(sorvicoRiadmoplotc.) Exhaust fan � <br /> Backllow provenler Hnat pump � <br /> _ Urinal Unit haator I <br /> _ Drinkinp Fountain _ Boilor <br /> _ Floor drain RofrignraUon i <br /> Groaso Uap Woodstovo <br /> = Rool drafns = Olher I <br /> Othor <br /> I <br /> CITYOF EVERETf LOC/LL SALES TA%I.�DE IS 7105 I <br /> I haroby cori6fy thal I have read and oxaminod lhis applicalion and knaw tho samo to be Wo and correct. All provisions ot laws and <br /> ordinaces povominp this typo of work will bu complied with whelher specified heroin or not.The granting of a permit does not presume <br /> to give aulhority to violato or cancol tho provision ot any other slato or local law regula6ng wnslrucUon or the perfortnance of � <br /> conslruclion.That I am authorizod by:ho o�mer ol Ihis pmperty to podorm Iho wodc lor which application is made and I wmply wilh tl�e i, <br /> �ConVaclors Law 1 .27 RCW and 296.200 WAC. �I <br /> �__ � �„_/.,.. `I • a v -0 9 , <br /> Signature of Owne ontr�ctodAulhorized Agent Date <br />