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- . � (� � <br /> PERMIT APPLICATION y-os-u <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEHETT,WA 98201 � f Odl" D/� <br /> 425-257-BB10-FAX 425-257-8857-www.everetiwa.org <br /> �S(� APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM S�L'�A � � D3� <br /> SRE ADDRESS PARCEL TAX I.D.• R <br /> �3A��lELV�N A�E ov5447n1AaoBd1 �DO ' OI <br /> LEGA LOTNO. OLOqC TRACTORBU�OIVISIONR <br /> DESC. �I.KpI - D-b) �-�7E �f' g S� 5 �20 FT. <br /> OYVNEp AD R <br /> WA. NoME OFyGUROWh1 PO�IC a`-'�d9' EVER6IT, VJA 982i3-oeSFA <br /> TENANTNAME CONTACTFORPEIMMT-5tWIK71.1 RO�INSC7►d <br /> 2FJRVhSCaf�tJP /�R[:I�IT�TS• 3eo.734.47�4 <br /> E�IAIL SkP1IhJ�.1ta'�'��'' •� <br /> M�RQAG...'•�.e�+zt w. 1z25 5. uJEa�.�2 vT s�i� soo/� <br /> CON7A.LICENSE R S�'T�LE�� 9S�'�'�' ls�C16�3:� •�'�Z � <br /> USE Of BUILDIN(3 I MEAT SOURCE I CONTHACT PRICE Of WORK <br /> MU�—T FAFt�L`�f 1-k�l►.K�• I <br /> �Electric _Gas_Other i,a�5� Of70(IfIG�•�71X�, <br /> WORK DESCRIPTION <br /> (J� '(,��^�RUQIDN� �uNiTAFFO�APBL� HoU��INEI� ��"�RY WOOAT�!-l8 °f' <br /> As��oc�ATED S�T� WORK, <br /> PLUM 1 G. ME ANI <br /> NO. TNPE OF FlI(TURE OR IiEM M�. TYPE OF FlXTU�E OR ifEM <br /> Toilel NC-air hendling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas pipirp <br /> Shower Water heater <br /> Kitchen sink&disposal Gee fireplace <br /> � Dishwasher Gas ranpe <br /> Clothes washer _ Clothes dryer <br /> Water heater Renpe hood <br /> Sink(service/bar/mop/etc.) _ Ezhaust tan <br /> Backflow preventer _ Heat pump <br /> Urinal UnRheater <br /> Drinking Fountain Boiler <br /> � Floor drain _ Refriperation <br /> Gease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVEHETT LOC�L SALES TAX CODE IS�105 <br /> I hereby ceritify that I have read and examined this application and know the seme to M true and correct. All provisions o1 laws ard <br /> ordinaces governing this type ot compiied with whether specitied herein ar not.The grantinp of a permit does not preeume <br /> to give authori ' Iate or cancel the prov • n ot any other state or local law reguletinp construdion or the peAormance of <br /> cons n. at I a ize y the er ot this property to peAorm the work for whkh application is mado ard I comply with the <br /> SI e Contr qors La 82 RC 200 WAC. <br /> � Zr �o <br /> ignature o ner ontractor u onz gent ate �/� <br /> Su>OS�S <br />