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( 1 PERMIT APPLICATION <br /> j `-� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425•257-f3857—www.overeltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS � 2��i•,,\ ' PARCELTAXI.D.a '� r 1 - , PERMI7p <br /> � , �,�j;u �� c C`�'J.TY'I[L,.+ <br /> �� ��' �� ta_t�d I ��5 0 �� <br /> LCGAI LOTNO. OLOCK THACTORSUBDIVISIONp <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE <br /> Ci� �� G�M,�:�k �a��c�,.�,,,,,�._ � _� �t� a �,�oi <br /> TENAN NAME CONTACTFOqPEHMIT PHONE <br /> � o-�-��� -I-� � 1 I� r� I���'��.0.—�-251 �?a� ' `��q 2 <br /> u�,�s�Nsc���� ao�c�a �-��= ,�.� ",NL_ �-�. �3sa- <br /> (dsrl�n � �" �l $2?� ��ok�5'�� ,�( <br /> USE OF RUILDING AT SOURCE CONTRACT PRICE OF WORK <br /> �� P�,� 1� ,_Eleclric _Gas_Otlier <br /> WORK D�SCRIP�iON <br /> iJc.�mc�o� a� �x�s-�i,n� 1p(u�li.4a i1�i , �vr�ov o. <br /> C�1�CS:rt.kr��a.clA� l?���'�, 1��C.1.Y1,�� Wc�.� � VeO��CA:�t-v�t�, <br /> �h �� � �-,- k <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEh7 NO. TYPE OF FIXTURE OA ITEh1 <br /> __ Toilct NC–air handling unils <br /> ._ Bathlub Forced air syslems <br /> _ Lavatory(wash Uasin) Gas i in <br /> Shower — �N 9 <br /> — Wa1er heater <br /> _ kilchen sink 8 disposal Gas lireplace <br /> ____ Dishwashcr Gas renge <br /> _ Clolhes washer Ctolhes dryer <br /> _ Wa1on c�aler Hange hood <br /> _ Sink(<crvicelbaUmo�uc;cJ � Exhaust lan <br /> ___ Backllow proventer Hcat pamp <br /> _ Urinal Unit heater <br /> _ Drinkinp Pountain �oiier <br /> __ Roorurain Refripera�ion <br /> _ Grease trap Woodstove <br /> ,_ Rool dralns Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify Ihal I have rea and �xmNned this application and know Ihe same to be�rue and correct. All provisions of�aws and <br /> cidinacos�overning thls type f wo will be complied witli whelher specilled herein or not.The granting ot a permit does not p�esumo <br /> lo give aulliori�y to violafe or c nce'Ihe provision ot any other state or local law regulating constmclion or tlia pedormance ol <br /> constiucll�n.T i n aulhor ed y th�owner of Ihis pmperty to pedorm Iho woik for which applicalion is made and I comply wilh the <br /> Stale ' .c rs a v 1 2 I C and 296.200 WAC. <br /> ' ' S-- v -0 8 <br /> Signa'ure ol Owncr/Contrac Aulhorized Agent Dalo <br />