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--- -- �J <br /> ---, -- -- -- <br /> PERMIT APPLiCATION <br /> � CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STRGET, EVERETT, WA 98201 <br /> ; 475-257-8810- FAX 425-257-8857-�wnv.everethva.r,rg <br /> � APPUCATIONS ARE ACCEPTED FRO�d 8 AM TO 4 ;'M <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT A <br /> ► 11 __ a�o5t`�-c�o� ocar �� IM � ZiI -o��l <br /> I LEGAI LOT NO. BLOCK i TRACT OR SU�UIVI910N# <br /> i DcSC. <br /> i <br /> OWNEP. AODR[SS CITY/ZIP PHONE <br /> � ��A�— �,��aa � q� e� <br /> TENAI7T NAIdE CONTAC7 FOR PER[�MI"T PHONE ��� �a� `�L,O <br /> I � � t (� `���,'�`r� E-tdAll�'%u 1�"1J �v�1�C5'U'V�✓1 <br /> I coNlxncroR .;t�s`%�^,�-� �� aoo y�r c� `5 I . �� �k�.�e i'�zv� <br /> � cor+�. uc� se a � L �j 611a� �C`l� �� rc ��1 C �:c m <br /> � . �U(�.r..,v,�'�D.��-1 � <br /> USE OF BUILDING I H[AT SOURCE I CONTRACT PRICE OF WORK <br /> �� � ' �'ec7�c _Gos�Other � �� <br /> l <br /> , ��Y1 �.���" l�c��- �l� Yv� ( � - kon <br /> I � PLUMBING MECHANICAL <br /> I NO. I 7YVE OF FlXTURE OR ITEh1 NO. TYPE OF FI%TURE OR ITEM <br /> i <br /> _ Toiiet A/C –alr handi�ng un�ts <br /> _ �ath�ub � Ported a�r systems <br /> , � Laratory(wash bnslni Gas pipmg <br /> ShoHer Walerhealer <br /> _� Kitchen?in�c 8 Cispnsal _ Gas fmplace <br /> � Dish•.v3sher Gas runge <br /> I _ Clothe,wpsher _ Clcthus�ryer <br /> Wafor hentcr Hnn;n hoad <br /> � _ Sink (5�7rviCt7!C��/mOp/Ctc.) � Exhaust fan <br /> dackflow preventer Hcat pump <br /> � Urinal ` Unit hyater <br /> _ �rinkin�Fountain Bo:ler <br /> i _ Floordrom Refrtporation <br /> i ` G�C'n9P.7ap � WOOdi�OVC <br /> __ Roof drrins Other <br /> Uther — —"--- <br /> ICITY OF EVFRET7 LOCAL SALES TAX CODE IS 7105 <br /> i I h�reby certify thal I hav9 road and examined this applia�tion and know the came lo ba Uue and wReci. All prov�sions o(laws and <br /> � ord!nnnr�s goveming Ih�s!ype a(work wiil be cempti?d v�ith�ti?;ether speclfiad herein or ret The granting cf r, perm�t does not presume <br /> to pive authodry tc viclote or cancel Iha provi;ion of any other s(ute or local law rogu!oNng construche�or th9 peRortnnnce ot <br /> cons ction. Thal I am authnriz d by the owner of this property to perforn the work`orwhich appllcalion Is matle and I comDly wilh the <br /> S�ato ontracters Law 1827 �nd G .20D WAC, � <br /> /' aturn ot`wner/Contrac rl u ionzed F�qent � � � A�� <br /> ( <br /> � __ <br /> — — - — � <br />