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�i � <br /> PERMIT APPLI�ATION ' <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810- FAX 425-257-8857 -www.everetriva.org <br /> �J C) <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> GSITE ADDRESS PARCEL TAX I.D.It RM�T a -/ I�I <br /> U C�E.?G/'EFN wAY 28'O�//3oG1D0,5'Oo Ci� i <br /> -GAL LOTNO. BLOCK TRACT <br /> �ESC. --- � <br /> OWNER ADORESS ��TY�LP �F W � <br /> Wnrt��o�� 'iNVal� S� �V�RC�?wot �2•-,uvx•�'LO--4 E�'�w" H9ua/!:+-se6�+��±Ci 9::.G6G � <br /> TENANT NAME� CONTACT FOR PERMIT PHONE �. <br /> �QLL••,�N� .Z� c: �/ka LiNEQ��,UIt 3Lo-67/- !/6S <br /> � <br /> CONTRACTCR 5'/GN�p4JS /MC AOORESS CITYlLP PHONE I <br /> i3�,u.coafsY B6ltU�CN�e1�WA ^r,�:�i �Lo-6:i--�iGI <br /> CONTR.LICENSE 71 `_ ;//_//17 � <br /> SlGN`-L' 1 "51LW UJ�cYv/ ; <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> /lr'S7n�� /�N' _Eleclnc _Gas_Other �OQ Q.O(� I <br /> I <br /> WORKDESCRIPTION �NT���ATwI� 6F �p,4t�r'wA% Mv�I��J CNAtiNdL L67'T��A- S/GN � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIX7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> '� Toilet _ A!C—airhandlingunits <br /> �� Bathtub _ Forced air systems <br /> Lavatory(wash bosin) _ Gas piping <br /> � Shower _ Waterheater <br /> �� Kikhen slnk 8 disposal _ Gas fireplace <br /> Dishwasher _ Gus ronge <br /> i Clothes washer _ Clothes dryer <br /> '� Laundry trey _ Range hood <br /> �I Sink(service/bar/mop/etc.) _ Exhaustian <br /> �' Backilow prevenler _ Heat pump <br /> Urinal _ UNt heater <br /> Drinking Fountain _ Boiler <br /> Floordmin _ Refrigeration <br /> Gre�se trap _ Woodstove <br /> � � Roof drains _ Olher <br /> Olhet — <br /> — � <br /> I CITY OF EVEREiT LOCAL SALES TAX CODE IS 7105 <br /> i, I hereby cenbfy ihat I have read und exa ed this application and know the same to te We and conect. All provisions of Imvs and <br /> �� orCmaces goveming this type of wo�ill compf with whether specifed herein or nol.The granting ot a permit does not presume <br /> j to give authority lo violale or ca el the�i ' ol ny other state or loral law regulatlng consVuction or the peAormance of <br /> I corstruction.7hat I am auth zed Uy e ner his property to peAortn lhe work far which application Is mada and I comply with the <br /> State ntmctors Law 1 RC 9G. WAC. <br /> � G ,�7 <br /> SignaWre of OwneqContracto Authorizetl Agent Oa e <br /> ���% <br />