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' ` P_.RMIT APPLICATIG _ � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ''� �� � <br /> �_,� �v��_� <br /> 425-257-8810—FAX 425-257-8857—vwvw.everetlwa.org <br /> J�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J <br /> PARCEL TAX I.D.A PERMIT k <br /> SITE ADDRES_S �,IC�uC� �{� /7 ?� v'� — <br /> � � � ( . <br /> �(3p LOTNO. �'], BLOCK 'R��T <br /> DESC. j-I <br /> OWNER � L��DDRESS _� �������P PHONE � ,�/ylrp <br /> �'�� � l�:��,�cr 9��' <br /> TENANTNAME CONTACTFORPERMIT PNONE <br /> I �I�"-'(�La l/ h eJ �125-'75� <br /> CONTRACTOR DDRE3S CITYRIP PHON <br /> ,6�Pmo-x-�- yza= s3 •.��v <br /> CONTR.UCEN�4E NL�1��L�`fa'v "/�� ! ���IO� G�p�L� �A- <br /> f� <br /> USE OF BUILDING I — MEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric ✓ Ges_Other <br /> WORK D SC� RIPTIUN � �O� <br /> eC�' LJI�J <br /> PLUMBING MECHANICAL <br /> ND. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> Toilel A/C-air hendling units <br /> Bnthtub / Forced eir systems <br /> Levatory(wash basin) 4. Ges piping <br /> I Shovuer L, Water healer <br /> �, Kitchen sink 8 disposal L Gas fireplece <br /> � Dishwesher � Ges renge <br /> Clothes wasfier 1 Clothes dryer <br /> Laundry tray _L Renge hood <br /> Sink(servicelber/mopletc.) �xheust 1en <br /> Beckflowpreventer _ Heatpump <br /> 'J Urinal UnK heeter <br /> _ Drinking Fountain '� Boiler <br /> Floordrein _, Refigeration <br /> Grease trap _ Woodstove <br /> Roof dreins _ Olher <br /> Other -- <br /> CITY OF EVERETT LOCAL 9ALE8 TI1X CO�E 18 7106 <br /> I hereby ceritify that I heve read and examined this applicetion end know the seme to be true and correal• All provisions of lews and <br /> ordineces goveming this type of work will be complied with wholher specified herein or not.The 9renting of e permft does not presume <br /> to give euthority to violete or cancel the provision of any other stete or locel law regulatlng canstmction ar the pedortnance of �ii�ih. <br /> constructian.That I am authorized by the owner of this property to perfortn the work for which epplicabon is made and I complY <br /> State Conlrectors lew 18.27 RCW end 296.200 WAC. <br /> � ����� � <br /> Signature o wned ontraclor/Authonzed Agent ate � � � <br />