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t�cRMIT APPLICATI�N <br /> CITY OF EVEREIT PERMIT SERVICES y �z0 ,.,,, � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everottwa.ag 6 06o y��y3 <br /> APPLICATIONS ARE ACCEPTED FROM e AM TO 4 PM <br /> SITE��S PARCEL TAX t.D.A �RM1T/ <br /> J ��k+�+ <br /> � �CO�� I (B4�1 Z� Yl�t i' � �-t��v� <br /> DESC. <br /> �j'��,oJ 1 v��a�,n,�¢-vt� pj "� ►wog ���� .wa R$zoG <br /> TENANTNAME CONTACTFORPERMR ��,P��� `�,'ZOO� <br /> c�'�O✓l °� ��Co✓� I V�C )V1 �rS� lit� 4Z� -�7CS ^lvg� o <br /> c cron O W�� anurteas crtrmP wa�e <br /> -�j�Ic.o� �✓1v24� ►�k5 '�Oi(i 419 • '2l»'� <br /> CONTR.LICENSE/ p'V Q'� 1200 4us•'LCig• (p�b'> <br /> C�� �¢ k� , vUR `1$�b <br /> �U�SE OF BUILOING HEAT tOURCE PRICE OF WORK <br /> `/� 1 � [/C. / �(/Q�'�t'� �EIBChIC,[+Ci88_�19f I �?�� <br /> 1, <br /> WORK DESCRIPTION ✓��,�� ��}� � r � u�11 <br /> �r,��Q Cv��--� �' Uva �� � ^ �..�_ <br /> �� `-i' d oo ./s � .'D � 1 w.. _ n L 1 / � <br /> i <br /> PLUMBIN(i MECHANICAL <br /> N0. TYPE OF flXTURE OR I7EM NO. TYPE OF FO(7URE OR Ii9A <br /> Toilet A!C—alr handlkg unNe <br /> Bathtub Fo�ced alr syalems <br /> _ lavatory(wash basin) _ Ges plpinp , \ �./, <br /> _ Shower � I A Wate�heater N rT-� <br /> Kitchen sink&disposal _ Gas 8replace <br /> Dishwasher _ Gas ranpe <br /> Cbthes washer Cbthes dryer <br /> Water heater � Re�9e►qod <br /> Sink(service/bar/mop/etc.) _ Exhaust(an <br /> Backflow preventer _ Heat pump <br /> Urinal Unk heater <br /> Drinking Fountain ��� <br /> Floar drain Refriperatl�xi <br /> Grease trap _ Woudstovu <br /> Roaf drains _ OtAe�_ <br /> Other <br /> CITY OF EVERETT LOCAL SALE3 TAX CODE IS J703 <br /> I hereby ceritify that I have read and examined this application and know the same to be hue and cortect. AN provlsbne of Iawt and <br /> ordinaces goveming this type of work will be complied with whether specifled herein or rat.The pranWq of a pem�it does not presume <br /> to give authority to violate or cancel the provision of any other stele or bcal law repulatlng construction or the pe�tormannce of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which applicatlon ia made and I comply with the <br /> State rs Law 1 7 R and 00 WAC. L�C <br /> ���� ����s� �� ¢i�1�� , <br /> Sig�alur o ner/ ontrac r Authonzed Agent Date �Z <br />