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� ,� r� - �0�O� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 — }I`-�� <br /> SITE ADDRESS PARCEL TAX I.D.X PERMIT 7! <br /> '� � M �(iOIG - �i�' <br /> LcGAL LOT NO. BLOCK TRACT OR 9UBDIVI910N 1 <br /> DESC. <br /> OWNER ,� ADDRESS CITYRIP pMONE <br /> �cuc� f r� Tu u�,Z q�9 �v l�-t. 5� Fc,; �'�2ar (�� �s-o�Q2 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> �ur�,ce�� S�f l�l� � �C Zr7v 4�a��� �' �`6z�c (v� zsz-3��y <br /> CONTR.UCENSE f <br /> l;l,�(Z��SSO ZZDT <br /> USE OF BUILDINO I HEAT SOURCE I CONTRACT PRICE OF WURK <br /> IZ�C� �Eloctdc Ges_Other <br /> WORK DESCRIPTION <br /> �'�t�l.M'SH L� ,�,,U57wc.� ��cG��� �jLirNl S�7�cf N�� ' ""�" <br /> PLUMBINCi MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> ___ Tollet A/C—air handling units <br /> ____ Dalhtub Forcod air systems <br /> _ __ La�atory(wash basin) Gos piping <br /> Showor Walor heator <br /> Kitchon sink 8 disposal Gas liroplaco <br /> .____ Dishweshor Gas range <br /> _ __ Clolhes washer Clothos dryer <br /> ____ Wator heator Rengo hood <br /> _ Sink(scrvice/bar/mop�etc.) Exhaust lan <br /> ____ Backflow prevontor _ Hont pump <br /> __ Urinnl Unit heater <br /> __ Drinking Founlain Bollor <br /> __ Floor drain Relrigaration <br /> Grcaso trap Woodstovo <br /> Rool drpins Other <br /> OthOr '-- <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J705 <br /> I hereby ceritily Ihat I havo read and oxamined Ihis applicalion and know Iho samo to be truo end co«ect. All provisions of laws and <br /> ordinaces goveminp Ihis type of work will be compliod wilh whether speci(ied herein or nol.Tho granting ot a permll does not presume <br /> to c�ive authorily to violalo or cancel Iho provislon ol any othar state or local law regulating construction or the pertormence ol <br /> consiruction.That I am aWhorized by tho ownor oi Ihis propody lo pedorm the work lor which application is mada and I comply with the <br /> Slato Co�t�c�ors L w 18.27 RCW and 296.200 WAC. <br /> �:�,� �/��/� <br /> Signat� eN-ONractorlAuthorizedAgent ate <br />