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� R^RMIT APPLICATII. ,V <br /> CITY QF EVERETT PERMIT SERVIC�S <br /> 32C0 CEDAR STREET, EVERETT, WA gg201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> —�-- o <br /> SITF i1U^F?F."" . / PARCEL TAX I.D.# V a a� <br /> �f�,7(� '�,- �� J . _. PERM # <br /> � 6'V • �� /'�_ .) i, ^ ' �� '0�/ <br /> — ✓� � -�/'�L l/'� I� <br /> LEGAI. � Np, 9LOCK TR�iC�RSUB0IVISIONq <br /> DESC. � �• / <br /> OWNER `�/ — r �� ��, L�I��� , <br /> ADDRE�4 V ' CITY2IP <br /> � �'�rl�:%'' �� _r;:•'i i i . -� . PHONE <br /> ✓,�-L , c��,�c l�� >✓ i'�-I� D�'� - Fi��l%�.,{� ;.�7 �f�=_ -:;'i��,; . .. <br /> TENANTNAMC- ' ' I G�I.' � i�/�;'' <br /> CONTACTFORPERMI7 PNONE / <br /> ��;`� q (� I�':tJF:G(1^_� <br /> CONTRACTOR i ���� ��_.�%'L, ��� /� �� I <br /> � - , f�;j ,� DDRESS E-MAIL ..P Ll�i%I%I/y"f�,'. i . <br /> L�'�:� �V;;;'i �•:/f:/�v 11 . ci`vi PHONC —"_---"----ii'7� <br /> CONiR.�LICENSE N i�,�C' � . � <br /> �j � (� : r.— %� /. , . � .'%/� <br /> - v 1/�!�l%1�• �/�I/, . /'�,�� �/i j�� • . . L v'v'✓v <br /> USE OF BUILDING � �� / ��.�u��J <br /> HEAT SOURCE CONTRACT PRICE+--pF W��K— <br /> i']� . � ,. .., I _ <br /> ��i .%•�!:�/LC�': :'��:i�i,. _L=leclrir. �� Gas Other � <br /> WORK DESCRIPTION I <br /> ,- ��izu.C.� � � 7 ��lL�A� I <br /> �'�.�';�r1"�i"i •r%'PLU / �'f/hr�'�i��/%,' l��% '���,/�,/ Ci�/�♦ i � ( �i� l. I <br /> /,' ; <br /> MBING �` �' 'i' . f�i''., <br /> MECHANICAL--�------ I <br /> NO. 7YPE OF FIXTUR[OR ITFM � <br /> NO. TYpE OF FIXTURE OR ITEM � <br /> j_ Toilr.l � <br /> 2 l3alhlub �l NC—airhandlingunits I <br /> I.I� Lavalmy(w,�sh basin) �— Forcetl air syslums <br /> �_ Showcr Gas piping <br /> __� I<ilchen sink&disposai Water heater i <br /> I Dishwasher _L Gas lireplace <br /> 1 Ciolhes washer � Gas range j <br /> � Waierhealer Z Clothesdryer i <br /> �� Sink(servir.e/badmoplelcJ � Ran�e hood i <br /> __Q_ �ackllow prevenler Exhaust tan ! <br /> _Q_ Urinal Q Heal pump I <br /> i <br /> _� Drinking Foimtain _/ Unit heater � <br /> p r-ioo�drain _2 �oiler I <br /> � Greasr. lrap � Refrigeration <br /> � Rool drains .� Woodstove <br /> _ Other_ _ Other—_ <br /> _ _ CITY OF EVERETT LOCAL SALES TA%CODE IS J105 � <br /> I herehy cerilify lhal I have read and examined this applicalion and know the same lo be tme and correcL All provisions of laws and I <br /> ordinaces goveming(his lype of work wil�be complied wilh whelher specified herein or nol.The granling of a permil does not presume I <br /> lo give aulhoiity lo violatc or cancel Ihe provision of any other s�ate or local law re�ulaling constn�clion or the performance of <br /> construr.lion. ihtif I anr�uthorizetl by the ov.-ner of Ihis pmperty to perionn the work for which applicalion is made and i comply with Ihe j <br /> Slalc ConlJa<itoi�.LaV:10.27 RCW and 296.200 WAC. <br /> �.-i :',' <br /> ��`��� 5����� � <br /> Signaiurr 1)f pwni.i7GonlraclodAulhonzed Agent — � <br /> � Date �/ <br /> ------------ - L � <br /> _ i <br /> `�--- 1 <br />