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i <br /> PERMIT A�'PLICATION <br /> �ITY OF EVERET� PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 <br /> 425-257-8810- F.�X 425-257-8857-www.everettwa.org <br /> APPLICATlONS ARE ACCEPTED FROM 8 AM TO 4 PM ��.. 4-,,� <br /> SITEADDRESS ��41`I �`r� ��`-`� PARCELTAXI.D. It PERMITif <br /> ,r.cr�ra.roy evs�-�rr, wp, 982c8 �S7 H 7 0o I o I (ao I �C�I I -0� <br /> LEGA LOT NO. BLOCK TflACT OR SUBDIVISION# <br /> DESC. �(p O�I S��-�i'Z !J\4i�� <br /> OWNER ADDRESS CINZP PHONE <br /> DuJ�'R�lI�J I�V�L6F}_.1�,tIT Co. 'Po 86�C IOSYi SACo+foM�s+l �}2S- 33`�- 5�18 <br /> 98�91 <br /> 7ENANT NMNE CONTACT FOR PERMIT PNONE c��-3l'7-801'7 <br /> T�P Il�ISU(]E1/\J� �(.�7,C7$ Ci'cPIT�tL/}RCJ�ITEC151NG. CA�p�'fialarchi-He'c15 <br /> e-Ma� rar+e�i;..,k.nrt <br /> �vc�'r w�sr- cbNs-r�urno/./ 'P,b."SoX 3S3S hRL�N�Ta,t.,l �2S-z9o-9t�9� <br /> corrrr+.uceNsea�-,��-�� ��K� 98Z23 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> OF�1CC I _Electric �Gas_Other ��S�OOp <br /> WORK DESCRIPTION <br /> P�l-�OV1/�6 oNE WALL J ADDI1.16 /�lEW wAt,l,S 'Ta �C7Fl� o'F+F�CES <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> ICitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer Clo�hes dryer � <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floordrain I Refrigeration <br /> Grease irap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COD£IS 3705 <br /> I hereby ceritify ihat I have read and examined ihis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing thir, lype of work will be coinplied with whether specified herein or nol.The granting of a permi�dces not presume <br /> to give authority to viola;�:or cancel the provision of any other state or local law regulating consiruction or lhe pertorrrance of <br /> construction.That I am authorized by the owner o!ihis property to peAorm the work for which application is made and I comply with the <br /> State Contractors Law 78.27 RCW and 296200 WAC. <br /> ��,tcyH-C9i N.f.(� ��-�o-�-7 <br /> Signature of Ownsr/Coniractor uthonzed Agent Date �� <br />