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' ' � � <br /> PFRMIT APPLICATION <br /> CITY OF EVERETT PERMiT S�RVICES <br /> 's200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-2�� 3857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS �S1Z �v��5} pr, PARCELTAXI.D.N PERMfT#� <br /> o u �a ot��=o� - <br /> LEGA LOT N0. BLOCK TAACT OR SUB�VISION R T 'L <br /> DESC. 'L rz�� c.r�.� Qc�C� �D G V¢.d'�"Tf <br /> OWNER (�J S[+JtC��S L(A k�tc�"��DREP.S JITYlLP PHONE <br /> 'n✓ } ' (J�ud�J^ �' ,, <br /> U�Y �. .1�,�(�-�-� 'Z- �i�te5 � Or. rV�.Je�"`l a,=='� <br /> TE ANT NAME CONTACT FOH PERIAIT PHONE 2L�L,�•L Z�_3�7 6 <br /> � I. � <br /> l �- � �v�� ��� e�N� S��nr[�=M��kp��nn <br /> �6RTiiA� �F <br /> 7 '//� ��l <br /> CONTA.IJCENSE 71 \ �D 1'��S 1,�� <br /> � � / <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WOPK <br /> Electric Gas Other �UDO <br /> WORK DESCRIPTION <br /> �P�U� 3 P,�k�� A�� 3 Q.� i s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlX7URE OR ITEM N0. TYPE OF FlXNRE OH REM <br /> Toilet NC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range twod <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Neat pwnp <br /> Urinal Unit heafer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Root drains Other <br /> Other <br /> — —i <br /> CITY OF EVERETT LOCAL SALES TAX CO6E IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws a�d <br /> ordinaces governing ihis type of work will be complied with whether spec�ed herein or not.The granti�g of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> consiruction.That I am authorized by the owner of this properry to peAorm the work for which application is made and I comply,vith the <br /> Sta ors Law 18.27 W and 6.200 WAC. <br /> ) �1 <br /> �.r= � 1 V r7 ' 7�O�l <br /> Signature of Owner/Lontrad�nied Agent Date ! �" � <br /> 1 <br />