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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everet,wa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 -a7 -�� <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT 8 <br /> / �l l / ,, ,, i r 30 � n�- O,�On 0,��7 0 -Gl7 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVIS ON N <br /> DESC. �'� �i F. _Yf.$ <br /> OWNER ADORESS GINIZIP PHONE <br /> / � <br /> � ,�. -�� ,, „-� 1�.��, -�:�, ��;�, .� , r,, r-:,_��-��-7�;��� �y;��;�� �o z <br /> TENANT NAME CONTACT FOR PERMIT PHONE r�- �`-�:�/7 c �� <br /> /l�y �j i7. �/ i� � /l,• .l( � �% E-MAIL %i�., l� .��'�?✓ ����Ci�',; ..�e'"J <br /> 0��T3R • ADDR SS TYIZIP P O <br /> / � i 1 ;�. <br /> CONTR.LICENSE N <br /> USE OF BUILDING — HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ � �, [lectnc �Gas_Olher �'7/�� � <br /> � . J :�. � <br /> WORK DESCRIPTION y 'J /� <br /> �.� c /,� ,� - ' , v�G�c'�6L.t-f'i'_ / �n. ..�v'i <br /> /.� r .Y�/J/Jv.�� J J (7/' C' <br /> �,-��;�-�,.:,- � y = / � - <br /> �_.,�-. aL- l�' .: ��1/ /'c7 n f G I UFa1 S>9R�uE !n� ��1�c A�+ D U�.r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �,_ Toilet A/C-air handling units <br /> _1 l3alhtub ' Ferced air syslems <br /> ? Lavatory(wash basin) _ Gas piping <br /> �_ Showrn _ Walcn c�ater <br /> Kilchen sink&disposal Gas lireplace <br /> Dishwasher Gas range <br /> � Clothes washer � Clolhes dryer <br /> Walcr healer Range hood <br /> Sink(scrvice/badmoplcic.) _� Exhaust fan <br /> Dackflow prevenler � Hr,al pump <br /> Urinal Unil hcaler <br /> Drinking Founlain . Boiler <br /> Floor drain Refrigcralion <br /> Grease trap Woodslove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS J105 <br /> I hereby ceritify Ihat I have read and examined this applicalion and kno�v Ihe same to bo true and correcl. All pmvisions o(laws and <br /> ordinaces goveming Ihis type ol work will be complied with�vhether specified herein or noL The granling of a permit does nol presume <br /> lo�ive aulhorily to violale or cancel the provision of any olher state or local law rec�ulating conslruction or lhe per(ormance of <br /> construclion.That I am authorizecl by Ihe owner of this property lo perfonn lhe rrork for�vhich application is made and I comply with the <br /> Slata Contractors Law 1II17 RCVV and 2�J6.200 WAC. <br /> _ � <br /> ��/�l i F' - i .� 10 % <br /> -/_.. <br /> Sic�n�Own�lCanlracloriAu�horized Ac7ent Datc � <br /> � �L <br />