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, �ERMIT APPLICATI"'N <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 /> � <br /> � � � APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE AODRESS �� �1I���/j-� PARCEL TAX I.D.* PF.RMIT� �I <br /> W1 � � <br /> LE LOTND.� BLOCK TRAC7 <br /> DESC. <br /> OWNER ..,�,.�f-.. DDR CITYlaP PNONE � ,�yl.� <br /> //�(J/u.� � �y'� y��vEl�oz (���icr 9��' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �l�'�[�c l/ heJ �2�t�-75�{ - f <br /> CONiRACTOR L. Am� DRE85 ���P ��N�� ���0 <br /> dJ�-{' <br /> ���.��E��ma���r� 9�� 5�-�.U�/a� �t�'�i� ki�- <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �es_Other <br /> WORK D SCF RIPTI�N � <br /> �[�;bu�e� ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI)(TURE OR ITEM ND. TYPE OF FlXTURE OR REM <br /> � Toilel A/C-eir handling units <br /> � Balhtub Forced eir systems <br /> Levatory(wesh basin) � Ges pping <br /> � Shower L, Waterheeter <br /> � Kitchen sink 8 disposel ,L Ges fireplace <br /> � Dishwesher 1— Gesrenge <br /> Clolhas washer 1 Gothes dryer <br /> _ Leundry trey ,�t- Renge hood <br /> Sink(service/ber/mopletc.) _Exhauat fen <br /> BackAow preventer Fleet pump <br /> V Urinal UnitMater <br /> _ Drinking Fountein '� Bdler <br /> Floordrein _ ReMgereUon <br /> Greesetrep _ Woodatove <br /> Roof dreins — �� <br /> — aner — <br /> CITY OF EVERETT LOCAL BALES TAX CO�E 18 7106 <br /> I hereby ceriUfy that 1 heve read end examined this epplicetion end know the seme to be We and cortect• AU Provis�o�o11�wa�nd <br /> ordinaces goveming this type o1 work will be complied wilh whether apadfied herein or not.The 9renting of a pertnft doea not pra�me <br /> to give authority to violete or cancel the provision of eny other stete or local law reguletlng construction or the pe�formance of <br /> construdion.That I em euthorized by the owner of this property 10 perfortn the worlc(or which epplleetion fs mede end�c�Pb'��° <br /> Stete ConVedors Lew 18.27 RCW and 296.200 WAC. <br /> 1(' " � /- �, � <br /> 5 gnature o er/ ontradod orizad Agent ne i/L <br /> I <br />