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� cRMIT APPLICATI.JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM e O b / ' Oa <br /> SITE ADORESS / PARCEL TAX I.D.# PERMIT# <br /> � ra•. c� �'i� Ov ��t (00 "00 —C7 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. C� Z Q � 4�f . o 'v�rp <br /> OWNER A DRESS CITY2IP PHONE <br /> ��l�ac �� �l7UQ 1(o'lf� $� .$1iJ � LvwKwoo[� l�� �lr'08� 42r`L17-S1�4' <br /> TENANTNAME CONTACTFOR�PER IT PHONE <br /> �O Yl.-t ( Sc..�.i.0 Cc5 ��UAF ( E-MAIL <br /> RA T � ���-Q� A � / <br /> CONTR.LICENSE p <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I i_ <br /> ��p �� 1 .X _.Electric �Gas_Olher yf�'�O�J D p <br /> �� �.e � <br /> WORK DESCRIPTION �1 / r � <br /> v�� �.; r �V r �r lYct.+1Q. -Q Q are« d;5��.���d � fc�+..o�tcl � � S�t�F�e <br /> �.;.� � � p�„P-�� l-y . `�fwr ,� s r�� ��w�.t�{ �,...;ti�, � P�u�b,�,�� � e1��1�� ( <br /> -� r n.e�a �n.�ls ��...e r b�.s.e K��� l..t-, b«�4 ��. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX'fURE OR ITEM <br /> � Toilel _ JC-air handling unils <br /> 1 Balhlub Forced air syslems <br /> � Lavalorypvashbasin) � Gaspiping far��.c4 du-'kr <br /> Shower Waler healer <br /> 1 Kitchen sink&disposal Gas(ireplace <br /> � Dishwasher _ Gas ranc�e <br /> �_ Clothes washcr Clothes dryer <br /> Waler heater � Ranc�e hood <br /> Sink(service/bar/mop/elc.) I Eshausl fan <br /> 6ackflow prevenler _ Heal pump <br /> Urinal Unil hcaler <br /> Drinking Pounlain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodslove <br /> Roo(drains Olher__ <br /> Olher <br /> CIN OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this 2ppiicalion and know Ihe s2me lo be true and correct. All provisions ol laws and <br /> ordinaces governing this rype of work will be complied wilh whether specilied herein or not.The granting ot a permit does not presume <br /> to give aulhorty lo violate or cancel lhe provision o(any olher state or local law regulating construction or the periormance ol <br /> construction. That I am authorized by the owner o(this prooerty to p�Aorm the work for which application is made and I comply with Ihe <br /> Sta ct�-s Law �71� �i 2 .200 WAC. <br /> / / � <br /> Si� ,,L � a.�� � /2�30 /20 o S' <br /> ure o(OwnedContracl riAulhonzed Agent Date � <br /> I '� 2 <br /> I�_ — — --� <br />