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i � =RMIT APPLICATi�N <br /> ICITY OF EVERETT PERMIT SERVICE5 <br /> 3200 CEDAR STREET, EVERETT, WA ggz01 <br /> I 425-257-8810- FAX 425-257-8857 -www,everettwa.org � <br /> _�92�� - �S//�/G{ �APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �a8,� {� I <br /> SITE 40DRESS �_. <br /> i�/�,'�%} L PARCEL TAX I.D.# PERMI7 i� <br /> i . , � <br /> � <, , . , - '� , : � , '✓���:- � �-;-;;^_ O;� � �Ckf -13 <br /> LEGAL L(�TNO, BLOCK TR CTORSUBOIVISIONi� ' <br /> DESC. � j �I�/ .� � <br /> ,_. � �� S <br /> OWNER <br /> .. AODRE�9 V ' C���,21P <br /> PHONE <br /> I�,� '/ � ,r ', �' .�L'; ' � ' �J% ` � , <br /> v�/. i �// ��J�i l ✓ �'2�',� � i)h� ��'- /� <br /> ���� ) � �' <br /> i[NANT NAME !/'� t�I !"v� `=L��T L�� ��� ��i��� � <br /> CONTACT FOR PERMIi PHONE <br /> � �� C��.l;�-r�:� J)i�/� �/� ���Lf:«�-.� � <br /> l . 1�/�'II N E-MAIL���, i I(� � <br /> ��1�/ ���`'�/ �:'%f'./�� ��;��� � RES6 I /ZI� �'0N i �/ r' � i��lf <br /> CON7R.LICENSE ry i;',-�' •, ^ I <br /> �� � . J ry : -._ /:�L/.�-��';) <br /> � � �� �` J. T��/ / � ��•�? /� � -. . c� <br /> USE OF BUILDING ��'iJ <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> �!�/ .i;,�//�<�;���./�i`� _Electric JCGas Other � <br /> WORK DESCRIPTION "� - <br /> s��/L 3/.5 I <br /> �i'_o-�/i�i,i�i ;/ i, �', v.� 1' ciT,��/� �i�l /' ���i;��C%�;�'i/'/ /�/' I <br /> PLUMBING _��J�� �. [ 'v: � L /��l i '-- � <br /> MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM I <br /> NO. TYpE OF FIXTURE OR ITEM I <br /> _�_ Toilr,t <br /> 2 f3athlub � aC–airhandlingunits <br /> y c?J' Lavatory(wash basin) �orced air systems <br /> __�,� Shuwer ��s piping � <br /> _� I<itchen sink 8 disposal Water beater � <br /> ! Dislnvaslier � Gas fireplace � <br /> I Clolhes washer Gasrange � <br /> C W��er heater � Clothes dryer � <br /> � �� Sink(servir.e/badmopletc.) � Range hootl I <br /> I _� �ackllow preventer 1� Exhaust fan <br /> _Q_ Urinal Q Heaf pump I <br /> _� Drinkinc� Fnuntain � Unit healer I <br /> P Floar drain _� Boiler <br /> i � Grease Irap � ReMgeralion <br /> � Ronl drains � Woodslove <br /> Othr,r Olher <br /> � — <br /> _ <br /> I , CITY OF EVERETT LOCAL SqLES TAX CODE IS 3105 <br /> I <br /> I hereby ceritify ihal I have read and examined Uiis apphcation and know the same to be We and correcl. All provisions o(Iaws and I <br /> ordinaces goverrung lhis lype of worl<will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to gi�•e aulho�ity to violal�ur cancel ihe provision of nny other slate or Iocai law regulating constnir,lion or the pertortnance of <br /> cunslrur.tion. That I am�iulhorimd by the owner of Ihis property lo perfonn Ihe�wrk lor whicb applicalion is made and I comply with the <br /> Slale Conlr�r,torS.Catv 10.27 RCW and 296200 WiaC. I <br /> , , , D�(�°�� <br /> Sipnalurc�of O�vnr.r nnlrac(or/Aulnonzed Agent I <br /> / <br /> --- ----------- I <br /> ------ --- J <br />