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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT,WA 98201 <br /> 425-257-881 l-FAX 425-257-8857-wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/-��D� <br /> SITE ADDRESS PARCEL TAX I.D.M PERMR N <br /> i�til A �� SF # ooS � oo� ool os� > :�511 -C)U <br /> LEGA LOT N0. BLOCK TflACT Ofl SUBOIVISION 1 <br /> DESC. ,t` <br /> OWNEH ADDRE$$ CIT'fLP PHONE��_36�'yS7� <br /> f�5 i'��per+�es ��C� � 2�>�� �-9l%C�M Wa,, NC Si��,rtle 4bi�.s <br /> TENANT NAYE CONTACT FOR VEH PM�E y,�'Z S'Sj�"(��(Z Q <br /> � Si (�OC Ci�.�,C�2��'C� �vi'Yj � S1 fc� � e.ua�Te.�l�''F�"R✓q �.JT/� Cc9i+1 <br /> Sy.w �ro� �Nc � rzv <br /> C4ts 685- 3�-�9� 3Z- <br /> cwrrn.ucerue�e o o�c 2 S' \ 6 `�Ze o v�n O�.1 O v.9 w � B �3 <br /> ssbntP'�o��rt '* � g � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> C..�mrne:C...a L. <br /> Electric _Gas_Other l � S Z o , o O <br /> i_:,,��-raKcy�c.J Sa�-� S — <br /> WOHK OESCRIPTION � 7`� �j( C�.� �,�.2 ��L�N (N�j <br /> � <br /> I�DnI ��Flee�l �J� � 17� v,�t� 11� r2���t�t� ✓i ay � <br /> PLUMBING MECHANICAL <br /> N0, TYPE OF Fl%TURE OR ITEM N0. TYPE OF FIXTUHE OR REM <br /> Toilet _ NC-air handling units <br /> Bathlub _ Forced air systems <br /> Leratory(wash basin) _ Gas piping <br /> �^ Shower _ Water heater <br /> iGtchen sink&disposal __ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes tlryer <br /> Waterheater _ Rangehood <br /> S!nk(service�bar/mop/etc.) _ Exhaust fan <br /> J Backflowpreventer _ Heatpump <br /> ^ Urinal _ Unit heater <br /> _ Drinking Fountain _ Boilar <br /> Floortlrain __ Relriperation <br /> Grease hap _ Woodstove <br /> � Roof drnins — - _ �I Othar — <br /> Olher_____ _ - <br /> CITY OF EVERETT LOC/�SALES?AX CODE IS 9105 <br /> I herehy ceri�ity that�have reud and examinod thi,applicntlon and know the same to be in�e and correct All provisions oi laws and <br /> ordinaces goveming Ihls Iype ol work wili be complied with v.�hether specified herein or not.The granting of a pe�mil doas nol presume <br /> to give authority to vidate or cancel Ihe provision of any other state or local law regufaAng consWction or the peAartnance ol <br /> conshuction.That I am authorized by lhe er th!s properry to perfortn the vrork for which application is made and I comply with the <br /> S[at::Contractor - 8.27 C�iV 'dgd 98.. AC. / <br /> ,-,l �✓ _C� a-' � I� /Jf`p` �[7/3L��1y t <br /> gnature o wnedCon rac r/Autho' ge °1C /Z ', <br /> � <br />