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� �� � , � <br /> PERMIT APPL��ATION <br /> CITY OF EVERE i T PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERET,T, 'vv,0 98201 <br /> 425-257-8810—FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TkX I�D,N PERMIT N <br /> icc�s- �, �1 A��. � ��r; 7cz ✓L'I r�o � 0�7 <br /> LEGAL LOT N0. BLOCK TRACT OR BUBDIVI810N N <br /> DESC. <br /> ` OWNER A DRE 8 ITYRIP PMONE <br /> UR_ I���'r—�:i �iuq�=; IGc7;5 - I�TH �4u•� � u7 482Q� 4t2t1 33� -� <br /> TENANT NAME � CONTACT FOR PERMIT PHONE4 ZS 2S Z -311`t <br /> SO�c�� 11,�.�-IYI-L I �1.."t-, S��•u E•MAILK2���cIOG' . SOU4tt, �Ouf <br /> A R <br /> l.�,C QG('�L't� o l�4 i� l�t-�?i v � �!;c c_ i c. C-U � � <br /> � L � ` �iZo { � � k��SZC,I (y-zs) 2�2- 3r�� <br /> CONTR�LICCNSE M <br /> (:-V�i2(�5�o22G l <br /> USE OF BUILDIN� I — HEAT SOURCE CONTRACT PRICE OF W(:RK <br /> Eloctdc Gea_Other I� Z 2 (i� �'`� <br /> WORK DESCRIPTION <br /> PLUMBINO H NICAL <br /> N0. TYPE OF FII(TUHE OR IiEM N0. TYPE OF FIXTURE OR ITEM <br /> ___ Tollet _ A/C-air handling unils <br /> _ Bulhtub _ Forced elr eystome <br /> __ Lavatory(wash basin) _ pas plping <br /> _ ;howar _ Weter heater <br /> _____ i<Itchan sink&di;posol _ pes Ilreplace <br /> ___ Dishwnshor aesranpe <br /> ___ Clo�hes washor Clothes dryer <br /> _ Wator heater Range hood <br /> _ Sink(service/bar/mop/etc.) Exheuet len �U�` �"—�f� <br /> ___ Backllo�v prevonter _ Heet pump <br />' _ Urinol _ Unll heeter <br /> __ Drinkinp Fountain 8ollor <br /> __ Floor drain Anirigeration <br /> __ Groasa trep _ Woodstove <br /> _ _ Rool drains 0 er <br /> -- Other __ I ct V ' � ltslt[avT <br /> ICITY OF EVERETT LOCAL SALE9 TAX CODE IS�106 <br /> I herehy ceritily thal� have read and examin�d this applicntion and know tha same to be true and correcl. All provisions of laws and <br /> ord�naces goveminp this ty�o of work will be complled with whether specllied horeln or noL The prenting ol a permit does nol presume <br /> to�ive authority to violato or cancel Iha provis�on ol any other state or locel low regulating consiruction or lhe pertormence of <br /> construction.That I am authorized by Ihe owner of thls property to pedorm tho work for whlch applicalion is made and I compiy with the <br /> Stato C n�ractors Law t6.27 RCW arld 296.200 WAC. <br /> Y�t�v..Ei �J� . ��w<� �l-/� I� <br /> Sic�natuic of wnor/ ontractod ulFionzod Agent ate <br />