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PERIIliIT APPLIC,A�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �b ,� I�-1 �- I/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �10 dlo - q5TM ST s�"'� 40 584�1 00l �o� 00 �\\7i - O�g <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION tt T Y�' S Q <br /> DESC. '� 3 lIo�00G — 2q - O4 - 3Co - �E <br /> OWNER ADDRESS CITYIZIP PHONE <br /> M4YLK-+ LAv1�1DA (0513- 14�artN ST S� �TJM6t�lY�S �15�'iqS- l0$5 <br /> �"�A 1 LL I pHONE Lf'Z.C��444 - Iq2s <br /> TENANT NAME CON7:�.CT FOR`PER�MINa1�i <br /> 1`1��, Ii�EYLNiTTlr�U �aAl.tlES e.tma�k0.m1 i ��+I S•ccw� <br /> p(L�STIC�i"c I�NoVATloc�1S (0513 — l4cvT« ST S4�I �Dt`tdrlDS k2s�14s- Iax <br /> CONTR.LICENSE# P��ST��' q 34 pD exp !o�q �2o i ! <br /> USE OF BUILDING {� I HEAT SOURCE I CONTRACT PRICE OP WORK <br /> �4 5�0 (5? SF@ <br /> ����� /��(,Kou 7� ��,�x �Electric _Gas_Other ���Sf <br /> WORK GcSCRIPTION LLDD I �G' <br /> EXis1-,�v 4- P� � Pr coN�E���n t� rt�i - P�ex t3Y �I�hr��e <br /> STa�� �!� JE�I�I �ST 'Y 2ND �LpOV� "� �XLE4"[� Uhl �"� G �� <br /> u�G us � FR� V1� Pk• r'x z� TRi c� �rX . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXIURE OR ITEM NO. TYPE OF FI%NRF.OR ITEM <br /> Toilet _ AIC—air har ��units <br /> Bathtub _ Forcedairs,. � �O ��W I <br /> Lavatory(wash basin) ,* ND ,'�1�� _ Gas piping <br /> Shower _ Water hea[er �� �,��5/ <br /> Kitchen sink 8 disposal �� X�Yl-�SS� _ Gas 6replace <br /> — Gasrange �ION� <br /> �Clotlheswasher NON� _ C�othesdryer MD�(�� � <br /> Water heater f•/tOV�iO _ Range hood <br /> Sink(service/barlmop/etc.) _ Ezhaust fan �4_��'(�'L�G ��..1(y6 <br /> Backflow preventer _ Heat putnp cr��rr� <br /> Urinal _ Unitheater � �v7 r—�17�7E�Q� <br /> Drinking Fountain _ Boiler �MOV�p OU'I' �� <br /> ' Floordrain _ Ref:igeration � U� �T � � <br /> Woodstove �.OW 12 <br /> _ Greasetrap — other UJM�lh{FiD W I <br /> _ Roof drains V�..� I T <br /> O[her — Il p�� <br /> — — — To �rt�-� 3 vr�iT. <br /> CIN OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> � hereby certify that I have read and examined this applir.ation and know the same to be true and correct. All provisions of laws and <br /> ordinances guvorning this type of work will be complied vntF whether specified herein or not. The granting of a permit doas not presume <br /> to give authonty to violate or cancel lhe provision of any olher state or local law regula0ng construction nr the performance of <br /> construction.That I am authonzed by the owner of this property to perfortn fhe work for which application is made and I comply vnth the <br /> State .ontractors Lav+1827 R andi96200 WAC. <br /> "`-�- , 1 ��3 � t I <br /> Signature of OvmedContractor�thonzed Agent Date � / <br /> � <br /> ` <br /> C — —.: ._�.- :.._—,---., ..: <br /> _ . � . , <br /> ��. <br />