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I ` <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETT,WA 98201 <br /> 425•257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � --ITJ�� <br /> SITE ADDRESS PARCEL TAX I.D.K PER,Mr-�IT N��^ <br /> ��Ozi F�s�l C�rn,ti{ CC;•"'Jl1 �I�I `��IOZ g,�0 (J�1lJ'J�" � i�n <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION/ <br /> oesc. �� s`� �/s A �-o�. ,,_ F n e F� re.f+� �- a„�K vsv �-oo <br /> OWNER {� ADORESS CITY2IP PMONE <br /> C I IC�15C�� � (��= ��f�' ������ <br /> ���enn an�l I'l�nniCa �}�C',2� fus��- C�`r:�1 �vP�c�1���,�g�01 '��- <br /> TENANT NAME I CONTACT FOR PERMIT PHON ' �_ <br /> � �..2f.' U�A{41f�L 1_0.�ay�' S,,,,l,� ' f.a� �'1 <br /> EadA1L�z-+�,-,k�����I1(t�[ChOinPi.i1 � <br /> Z`�Ff�'AZT6p Illli��n�c� 11t�nr'�'> Iri'�-.�. :�'},�`1 l_.,,,wrrr�l`i2�0'�4 .• <br /> CONTR.LICENSEMi1LLII��I����I J��'�`� ���71�IL -I �J �� J <br /> USE OF BUILDING � I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> �a��, �,,J�'�, ( _ ".;1,. 1.. r��u�,�y �r; , <br /> f I Eledric Gas Other � �'7� ' �- <br /> WORK DESCRIPTION ��� <br /> � � �',��It' �ct.,vl..� �'r'Si�t'�iCF ^-. � S�(�� <br /> 11n1_� <<r1r� � l,r� -�t, c �xi^:1;,.� - <br /> j..1'�.i r ..,�i.<c� C��'`.i^� i �\L..� ,)QtIJ <br /> �5��; t.��� " �,jy�y�`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OH ITEM NO. TVPE OF FIXTURE OR ITEM <br /> .1 Toilet A/C-air handling units <br /> � Bathtub _ Forced air systems <br /> '1 Lavatory(wash basin) _ Gas piping <br /> Shower Water heater , <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwashcr Gas range <br /> Clolhes washer Clothes dryer <br /> Waler lieater Range hood <br /> Sink(service/bar/mop/etc.) Z�_ Exhaus�tan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> floor drain Relrigeration <br /> Greasc trap _ Woodslove <br /> _ Rool drains _ O�her <br /> Olher _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritity�hal I have read and ezamined�his applicalion and know the same�o be Irue and correcL All provisions of laws and <br /> ordinaces goveming�his type ol work will be complied wilh whelher specified herein or no�.The granting of a permit does not presume <br /> to giv=authority to viola�e or cancel the provision of any olher state or local law regulating construction or the pertormance ol <br /> construction.That I am authorized by the owner of this property to perto�m ihe work for which application is made and I comply with ihe <br /> Sta�e Con ra ors Law 78.27 RCW and 296.200 WAG.� <br /> �_..., . <br /> (- , ` ' � ^ ' �/��//C Y <br /> Signature b� �,wner7Contractor/Authorized Agent ate '� <br /> �\. ` <br />