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z �i <br /> ;n <br /> F �RMIT APPLICATIvN 'a <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P� S'"�/� -3 7 <br /> SITE ADDRESS PARCEL TAX I.D.# BERMIT# � <br /> y632 FoR�s� �iZ OO�i'195b�O���oO � �)� - 3� �I`,, <br /> LEGAL LOT N^0}.(� BLOCK T y / /n/ 1,' <br /> DESC. I� 1 V T �` �`_7C� F� C _�C(� � �'v� J� � � t', <br /> OWNER ADDRESS CITY2IP PHO E �, <br /> �-�(�(�C� ��.o►H�PS CO�Si, 39aa, a���l��E - N.e (i�, yZs�-39�• 736� �, <br /> EvE2G-cz l(�� _ , <br /> TENANT NAME CONTACT FOR PERMIT PHONE I � <br /> d <br /> � Sc�e,l Hc�,c�cZC � zf- Z�a- z y z � � <br /> � R��, CONTRACTOR ADDRESS CITYIZIP PHONE r; <br /> � �-ir��cu �Ro-n���es cbusT, 3qaa 0��i��E -N,C— �2S 3°�•�36� ;. <br /> CONTR. LICENSE# Q � <br /> i-1(a�C1c (3�'O I d 17 Z. �V E 2�TT l�aU,S ;" <br /> USE OF RU�DING I — HE�OURCE I CONTRACT PRICE OF WORK ' <br /> S�� 12S � !� <br /> , Eleclric Gas Olher <br /> — � <br /> - �.. <br /> WORK DESCRIPTION <br /> ,� <br /> �ASZC � ��1 � , <br /> N �.� s�� Ir� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE CR ITEM NO. NPE UF FIXTURE OR ITEM <br /> 3 Toilet A/C—air handling unils � <br /> � Bathlub � Forced air syslems f`' <br /> � Lavatory(wash basin) �_ Gas piping (' <br /> Shower / Vlalerheater . <br /> 7— Kitchen sink 8 disposal l (.as(ireplace <br /> �— Cishwasher / U:,s range <br /> L_ Ciothes washer � Cbthes dryer <br /> _ Laundry tray � Rdnge hood <br /> Sink(service/Uar/mop/elc.) Exhaust fan <br /> DackOow preventer Neat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler ' <br /> Floor drain Refrigeratiun i j <br /> _ Grease trap _ Woodstove � . <br /> Roof dreins Other ' <br /> Olher � ' <br /> � — — <br /> 1' <br /> � CITY OF EVERETT LOCAL SALES TAX.CODE IS 3105 <br /> II I hereby cerili(y that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordinaces goveming lhis lype nf work will be complied with whether specified herein or noC The granting of a permit does not presume <br /> to�ire authorily lo violate or concel lhe provision of any olher stale or local law regulating construclion or the performance of <br /> construction. at I am aulho ' ed by lhe ne of this property to perform lhe work for�vhich application is made and I comply wilh the <br /> St Contrac r ,Law 18. 7 R d 29 C. <br /> . \ <br /> Sig a re o c u on�e Age Date � <br /> _�-� �-' � � S-� ? :..�9 �� ` <br />';,;�r, >; — <br />� .a:. <br />--_-� _ — — — <br />