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-- �r - <br /> P�RMIT APPLIC�TIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S i REET, E\/ERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS AaE ACCE�TED FFOM 8 Ah1 TO 4 PM �.(,��j,�� ;� <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT/#� p <br /> �`'� 1f�+ _ Cx�y3b'� - ZZlo -<x�i -Oc) � ovD ����1 <br /> LEGAL LOT NO. I ?!�CY. TRACT <br /> OESC. L„-r 1 EI2/a ZZ�a QLi�? 1- K^-" <br /> a l c-.vc;�c:-i`r � �rn� -� Pc, o <br /> OINNER ADDRESS CITYIZIP PHONE +/ZS <br /> ��� n C.r�P��✓�� � <,G- Ra. 1°x.;� �y6 ✓��: s;cv�s , wr1 SS��s� �y�c, ��G� � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> S'[t � W�4v��5 y2S �'S(v 77G 7 <br /> CONTRAC70R ���C��) /l_ � ADDRE� /� , �y� CITY2IP PHONE <br /> "�Wi f �i'l c - U. Ut�A <br /> Zs•3sv--, �c� <br /> COhTR.LICENSE# LX,_ STL-(���J• w� y,�zs,�., y <br /> ��/�r rJff �i� TL <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK ! <br /> '�U PCC� I _Eler,lric �Gas_Otber I <br /> WORK DESCRIPTICN <br /> (,'v✓/5-n:.�c�,uc� oi- ��1- JJPct;� <br /> PLUMBING MECHANICAL <br /> NO. fYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> _� BaUilub 'L For:ed air systems <br /> � Lavalory(H�ash basin) �_ Gas piping <br /> Shower 'L Waler healer <br /> _� Kitchen sink 8 disposal Gas fireplace <br /> Z_ Dishwasher Z Gas range <br /> Cloihes v+asher � Clothes dryer <br /> � Water healer ? Range hood <br /> Sink(servicr./bar/mop/cic.) !•� Exhaust fan <br />` _ BackOow prevenler Healpump <br /> Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined lhis application and know Ihe same to be true and correct. All provisions o(12ws and <br /> ordinaces goveming this type of work will be complied wilh v�helh�r specified herein or noL The granting o(a permit does not presume <br /> to give authoiity to violale or cancel ihe provision of any other slate er local law regulating construclion or the per(ormance of <br /> conslruction.That I am authorized by Ihe owner of this property lo perform lhe work for which application is made and I comply wilh the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> c—_ __. .l CD�l7/b� <br /> SignaWre of OHmedCo��or uthonzed Ager� Date � /L <br /> � <br />