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n. . , .� , � .. . ;� . . <br /> ��, �. � .. _, i J � ��n� - <br /> I �, <br /> PERMI�' APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.orq <br /> • AF'1'LIGATIONS ARE ACC�PTED FROM 8 ANf TO 4 PM <br /> SIT[Ab�RES . P�RCEL TAX I.D.if PERMIT# <br /> � D Z �Y�z J I �e.�t7 V� /l I � I U ' l�LG� <br /> LEGAL LOT NO, BLOCK TRACT OR SUB�IVISION t1 <br /> DESC. ' <br /> � OWNER pODR8S5 CITY�IIP pHONE <br /> ��YI �2Y` 4f-�J �9a62Za' <br /> 7ENANTNAtdE I CON7ACTFORPERIdIT PHONE(��� Z� ^(LJ <br /> '�e �.h,�� IebbieCc���h��+�.c ���t <br /> C�'1►,�u..��c� I►1c. ��1�i�� � w�a-�.� �vGreti q87.�i N252.5�I1o�6k� <br /> CONTR�L�i SE t ,, ����� <br /> 1�1 <br /> USEOrBUILUING I NEATSOURCC CONTRACTPflICEOF�VOHK <br /> _ �l�9� "r <br /> Ela�lric _Gas,_,_Olher <br /> WORK DESCRIPTION ��1�, �./� /�^ � Y-�Q � <br /> �IMJC.� (./�4l <br /> V <br /> PI.UMBING MECHANICAL <br /> N0. TYPE OF FIXTURE GR IYEW � NO. TYPG OF FIXTURE OR ITEtA <br /> Toilet FVC-air hantlling uNts <br /> Bathwb ^ Forcod air systems <br /> Lavaiory(wash basin) Gns piping <br /> � Shower Waler heaier <br /> � Kilchen sink&dlsposal � Gas fireplace <br /> � Dlshwasher � Gas rengo <br /> ^ Clothes washer Clothes dryar <br /> Waterheater _ Ranpoliood <br /> � ____ Smk(serviceibaumop/ela) Exhaust fan <br /> i = 8ack0ow preventer Hent pump <br /> � Urinal � Unit healer <br /> Drinking Fountain 80110� <br /> Floor drain ____, Refriperation <br /> _ Greasa trap Woodslove <br /> _ Roof drains � Other (►'LaGQ.- <br /> O�her <br /> CITY OF�V[RETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceri�ify that I have read and examined thiS applicalbn and know Iho same to he true and correCt. All pmvislons of laws and <br /> ordlnaces governing this type o(work will be complletl with whether specilied herein or no�.Tho pranting o(a permit does not presume <br /> I lo giva aulhorfly to violato or cancol iho provision ol any OlhCr slale or local law fepulating GOnSI�uCtivn or�he pEA0�n12t7Ce ot <br /> conslrucllon. 7hat I am authorizod by tlie o�vner ot thls proparty to pertorm Ihe�vork lor which appilca�ion is made and I comply with Ihe <br /> Stato Contractors Law 1827 RCW and 296.200 N/AC. <br /> ' � � . !o l0 �11:1�- <br /> Signaw of OwneuCoal actor/Aulh �z Apent Date� <br /> (i <br />