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i � <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.evereti�Na.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM q —a Y �D / <br /> SRE ADDRESS PARCEL TAX I.D.• RMIT M <br /> — ���� �Y� T 3�D3o/`I•G� r�^ 7�a:,�- �� <br /> LLGA LOT . BLOCK TRACTORSUBDIVISIONJI <br /> D[SC. <br /> OWNER �1DDHESS CRVTP PHONE`JZ S <br /> /� / i � <br /> TcK S���ft�/rc,� ti Z�f ��✓t.zG�'rSi �vP✓cf� .$SO�-�i7YC <br /> TENANT NAME COHTACT FOR PERI.IfT PIIONE <br /> I E-GAIL <br /> 1.1�I-/!�'c •l ��_ �, �z S� .� p <br /> CONTA.LICENSE p ���y <br /> �v����,����r� �aBi�a�r �I�ys��f/ z�� � <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> �x/�n . !'i �[leclric _Gzs_Olher D <br /> � <br /> J <br /> WORK DESCRIPTION <br /> �h.�Q�r ������ysfP� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlICTURE Ofi REM NO. TYPE OF FlXNRE OR ITEM <br /> Toilet NC—air handling units <br /> 8alhtub Forced aii systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> Dishwasher _ Gas range <br /> _ Clothes washer Clothes dryer <br /> Wate�healer Rango hood <br /> _ Sink(service�barlmop/etcJ Cxhausl lan <br /> _ Backllow preventer _/_ I leat pump <br /> Urinal Unit healcr <br /> Drinking foun�ain Boiler <br /> � _ floor drain Heingeralion <br /> __ G�caso Irap __ Woodslove <br /> Roo�drains Other <br /> -- Othei — ---.-._ . __.. .. <br /> CfTY OF EVEREIT LOCAL SALES TAX CODE IS 71J5 <br /> I hereby ceriufy Ihat I have read and examined this application and know the sa�ne lo be true and wrtect. All provisions of laws and <br /> ordinaces governing Ihis type ol work will bo complied wi�h whelher speciBed heiein or no�.The graming ol a permit dces not presume <br /> Io give au�honty lo violata or cancel the provisiai ol any other stato a h�cal law regulating construction or ihe perlormanCe of <br /> constr�ction. Thal :am authorized by ihe owner ol this property lo pe�lorm the wwk fa which applicalion is made and I comply with the <br /> State c'u W antl 296200 WAC. <br /> �� ` <br /> � `. � '�7�"C-��- ��—G--�—� <br /> 9fgnature of Ownet Gbntraclor/AUhonzed Agent ate <br /> L-- -- --- -.. ._ . <br />