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�� <br /> ��ER(VI17 APPLICAT s�ON <br /> CfTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �i��l � , ��: sr 3 /� 90 S 300 ��a � ��-��--= - (i <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. S ��„��� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �¢D l��c (�.� � c �'/o%�.x y�o ��:��23� 3�a-3�i-�F�oY� <br /> TC.NANT NAME I CONTACT FOR PERMIT PHONE <br /> � .��,,, .��u qZ� -/9,�3 <br /> CONTlRA/C�TO/RJ � nLL� ADDRESS CI7 t PHONE <br /> /�Y-L� /s•q/ (JZ¢1+�C <br /> CON R.LICENSE# <br /> i�A �kc�� o �z �� �''/o��n9i° C� , 9�z�� 3�v.���- u��y <br /> USE OF BUILDING � HEAT SOURCE � I CONTRACT PRICE OF WORK <br /> S� ' I _Electric �Gas__Other / / 00 U <br /> WORKDE CRIPTION � �7��JVJ,���(1G G'iQOUA/p RIC�- <br /> ��� /�czt� ���_� �o.�/c�p£T� SLi�,��w /,vsv«aT.o�! i <br /> PLUMBING MECHANICAL � <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIIRE OR ITEM <br /> "��t� A/C--air handling units <br /> _ BaEhtub _�,-Forced air-systems <br /> _�.avaloty�wastibasin) �--_�S_n�Pi�y_, <br /> Shower _L Water!�eater <br /> L, Kitchen-sink-8-dispasal ±-- -Gasfireplaco <br /> _L-Dishwasher G2srnge- <br /> � Clothes-wesher � Glothes dryer <br /> _ Laundry t2y /- Rangehood. <br /> Sink(service/bar/mop/etc.) .� E�Maust-faa <br /> � Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> �-Fbordrein Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CO�E IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same lo he true and correct. All provisions of laws and <br /> ordinaces governing this type of work will bo complied with whether specified herein or not.The grarrting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating constructien or the performance of <br /> consWction.That I am authorized by the owner�f this property to perform the work for which application is made and I comply wilh the <br /> State Contr rs Law 18.27 RC 296.200 WAC. ' <br /> /i��'7 �G�����`. ?-i�5�- O.S <br /> Signature of OwnedCo tractor/Aulhorized Agent Date <br /> I <br />