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� �RMIT APPLICATI..�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8H10— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � 7 PARCEL TAX I.D.M PERMIT p <br /> �SoS Ruci��r. 0��-�3�n3�noo 30� : po�- -oac.� <br /> LEGAL LOT NO. B-L7O-C�K TRACT OR SUBDIVISION p <br /> DESC. 7 �t� 7 �O •C V��F-'T j�l✓ !i <br /> OWNER . ADDRE55 CITYIZIP PHONE <br /> L �ti<<7_+�2 , f� � /1^E',�-va I8�5 lzuc���Q— /� _ ✓r-¢E�r 4Zs �i � <br /> � �z�t G,S �? <br /> TENANT NAME CONTACT FOR PERMIT PHONE �Zc� Z 3 Z �K�j Z <br /> QVl//J�IZ � � JofW QU°�LSoU/-+� E•MAIL J,vi, oa�f•.5ouu+ � <br /> R '�2a T�"✓[�„'Pna��a.�_ I I <br /> � Arv9 (ONZT'/LUGTt+J ���c;• a0)L 1 Z 32L �.lJ <br /> �fZS — Z�Z ' <br /> CONTR.LICENSE N <br /> P�olkuc �ibzoC� �j,4zoL ��( �-i <br /> USE OF BUILDING ' HEAT SOURCE CONTRACT PRICE OF WORK <br /> C or� ' <br /> S� �Z _Electric _Gas�Other 1 7� <br /> WORK DESCRIPTION �"� �M a� <br /> '�'j{�TNiKCY'r'Yi 2f✓�+�'Dct. A-DD �if?oWF�-- i�E?��� W�T�-fL <br /> G�.t„4s I J <br /> `� �I%�NVl�.v„� �,,R- (,✓rly��3'� ` se 2✓,cU S �.-i'L, A^�a /�4 v'F{'+z'/�--y� <br /> R£' ��".4'�k. w�t rF-T` ��"iar�l.�. � 14J0 �97H Ff�nl � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> lbilet NC-air handling units <br /> �athtub Forced air sys�ems <br /> �_ Lavatory(wash basin) Gas piping <br /> _(_ Shower Watei hea�er <br /> Kitchen smk 8 disposal Gas lireplace � <br /> Dishwasher . Gas range <br /> _L Clothes washer Clothes dryer , <br /> I Water hea�er Range hood <br /> _.�_ Sink (serviceNadmopletc) �_ Ezhausl fan <br /> Dackllow preventer , hleat pump <br /> Urinai , Unit hea�er <br /> Drinking Foun�ain Boiler <br /> Floor dram Refngeralion <br /> Grease Irap � Woods�ove <br /> Roof drains Other <br /> Other <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify Ihal I have read and examined Ini;dNplication and know the same to be true and correcL All provisions of laws and <br /> ordinances governing Ihis type of work will be comp6ed wilh whether specified herein or noL The grenting of a permit does not presume <br /> lo give authority to violate or cancel ihe prw�sion of any Mher state or local law regulating consirudion or the performance of <br /> construction. That I am authorized uy ihe o�+ner of this property to pertorm the work for which apphwtion is mada and I comply with the <br /> Slate Con�r dois w 1827.�3GW and 296:`00 WAC. <br /> ' � � <br /> 2�A � A �-Z.l.�— � b <br /> Signalure of O� �er/,onUact /f1 honzed g Date <br /> � � <br />