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� <br /> P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> S�TE ADDRESS q-1,.{.� - PARCEL TAX I.D.# PERMIT# <br /> � u�,K n• 7 i, 5 G�l� <br /> LEGAL ItOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DE5�.1 CO Co/jq 3COOOOi�DO <br /> OWNER ADDRESS CITY2IP PHONE <br /> ozov -78a- �aa � <br /> C~F�- �k►'/(Q �.' �tn��_S LL� /I(r/�'/ (o3��c�_� P�va!(,�c�Cd4. 98�?� <br /> TENANT NAME � I CONTACT FOR PERMIT PHO E <br /> E•MAIL <br /> �ei or 3�.�� f.:ood la,,�� �i,�k�:� �6 -�v3-aa�G <br /> CONTR. LICENSE N /�P� 1/�e �Q' �B�D� <br /> J A� <br /> USE bF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ----------- ----1— �f-lcr,lric __Gas__Olher I � 7,�S�'�'C./ -- <br /> WORK DESCRIPTION <br /> fPPI6� E. ,�oco f -t�zSPs, ��rw����,�� <br /> ------ - -- -- PLUMBING - - -- ----- — — MECHANICAL � <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FI%TURE OR ITEM I <br /> � . �' Toili�t A/C–air handlinc� �mits <br /> � �I f3etlhlub _ Forcod air syslems <br /> � _ d� L,wr'ury (wash basin) . Gas piping <br /> Sho..rr Water haaler <br /> / Kilr,h�.n sink 8 dispos�l Gas firepla�e <br /> / __ Di�hw�ishcr Gas ran�u <br /> - -_ Clolh��;wnsher Clothes Ary�er <br /> ___ Waton c�eler ��(_ Range hood <br /> .._ Sink (scrvicr./bar/moplr.ir.J /�_ Exhaust fan <br /> ... . GacAllow preveNer Heat pump <br /> Urinal Unil healer <br /> � Drinking FouNain _ Boiler <br /> � I __ Floor drain _ helric�ere�ion <br /> _ Grense irap __ WoaAslo�•e <br /> ' Roof drains Ulher <br /> Olhcr <br /> ICITY OF EVERETT LOCAL SALES TA)(CODE IS 7105 I <br /> �I hereby centity Ihat I have rr.ad and�xamineA Ihis appGcahnn and know lho same lo be true and correcl. All provisions of laws and � <br /> � ordmacr.s qoverning Ihis type ol work will bi�r.umplir.d wilh whethm spr,ci(ied herein or nol The granling of a permil does not presume <br /> I lu yivo aulliorily lo viola�o or cancel Ihe provision ol any other slale or local law regulating construction or the pertormance of <br /> conslruction. Thal I�in aulhorizrd by Ihe ownr.r ol lhis property�o peAorm lhe work lor whir.h applica�ion is made and I comply wilh Ihe <br /> � Slale C ��actors La�v 1tl.27 F�CW and "196.200 WAC. <br /> .� <br /> �' �� ��S�x�--- 9-a6 -��� � <br /> � Signa re ol Ownerl�onlracbdAuthonzed Agenl Date <br /> �_ ._. . __.. . . . _ ._. . . I <br />