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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, UVA 99201 <br /> 425-257-8810–FAX a25-257-8857–www.everettwa.org <br /> —� <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 pM � 2�-�q'���� <br /> SITE ADDRESS PARCEL 7A7(I.D.A PERMI7 R <br /> O � v'�u,� (3\� D oo /i I►- Oz-p 8 <br /> LEGA �OT MO• BLOCk TRACT OR Sl1BDMS10N i! <br /> DESC. <br /> owNER ADDRE53 piYlLp PMopE <br /> � 1 '�.[�bt�h � -c S <br /> TENANT NAME 1 CONTACT FOR PERMIT pHONE ' �� �a� �JO <br /> I�.+(Yl.i � (� C.7f L�"�./�.Pa'1 E.MAtL�]W IYU<i;t�I CA'W1o..I1 <br /> co c r R ,t.r�lr�o.T �r� wouREss 4�t i I cin iP NnoN�f-ti . <br /> P� s�.+��.� a�� aa� ���, «,, <br /> CONTR.LICENSE 7� g���\`�n �� � �j FiV�6 <br /> ` �'� <br /> USE OF BUILDING HEAT SOURCe cONTRACT PRICE OF WORK <br /> 5�R _Efec;nc ✓s_Other I�� g Q q <br /> 1NORK OE CRIP ION <br /> \ Y� s�`� Ola � r� ��ac �.. <br /> PLUMBING MECNANICAL <br /> NO. 7YpE OF F7XlURE aR 17EM N0. 7YVE OF FIl(iUR[OR rtLM <br /> _ ToilCt , A/C-afr handling units <br /> eathtub ____ Forcod air sysfems <br /> ____ Levalory(wosh basin) <br /> � Shower � Gas piping <br /> Weter heater <br /> _, Kltchen sink 8 disposal � Gas flrepiaoo <br /> _ Oishwar.hcr _ Gas rpnge <br /> � Clothas wosher _ Clethes d er <br /> Water heeler ry <br /> � Slnk(,crvioelber/mnpfetc.) , Rangc hood <br /> � Backflow preventer .� Exhaust fin <br /> Urinul _. NealDump <br /> _ Ddnking Fountain � Unit hqater <br /> Floor drain — AO��O� <br /> _ G'r.aso trap �_ ReMSerallon <br /> a Raof dralns : �loodsfave <br /> � OUICf � Other <br /> ,I <br /> C�TY OF EVERETT LOCAL SALES TqX CODE IS 7105 <br /> I he�eDy cerlify tnat I have roatl and axamined this eDp�cation and know tho oamu to be tnie and corra�}, All provisions of IawS and <br /> ordinanoos govnrning this rype of work will be compliad with wheBior specificd hercin or not. The granting of a prrtnit does not o�asume <br /> ro grve auUrority to violate or cancel ihe prpv�sion of any other sFatv or lopl Inw regulating oonstNction or Me parfortnanc�o( <br /> mn cnon.That I am aumoriz d by tl�e owner ot 1hls property to peAorm tha work for which appllcuHon is mado and I compty wi(h the <br /> Sfnta oMracrors Lew 1827 and 200 WAC. <br /> aNre of ner/Contr, ; rlAu iotiZea A ent � I � ' � <br /> 9 Dale <br />