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� � <br /> P�RMI'� APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADORESS Q F� 5��� PARCEL TdX I.D.fl PERMR# <br /> �(�ri��- E'✓�c-2ti�� �J�c c�vEeti�-r ua-��Z 3 0�r�- czk <br /> LEGA LOTNO. BLOCK 7AACTORSUBDIVISIONit <br /> DESC. <br /> OWNER ADDRESS CITY�2I�P'1 PHONE <br /> ��C, I �I I G, �/��' `�ccE va��4 �I� �o �,�-i �/h'- NSr�9-1�1 <br /> TEN'�N1T NM�IE CONTACc FOR PEfiAAIT PHONE �f�'J'-�S'�• 3(p�D <br /> V�-1 d �1�� / I �C L!L /r���� E�1AILu�I G!L n�l<i G.' Aif,��/lI /� <br /> "- ' J,�f-�v ' �a;2f �is� yvs`z� �u1/.��£,1.��-`��oir `�1f3s`l �l�lp <br /> rGrl,l,tUr ' <br /> CONTR.LICENSE N <br /> �}7 f�' `aUA�/11 1 D �o l iL/�- <br /> USEOFBUILDING I — HEATSOURCE ONTRACTPRI OFWORK <br /> Eleclric _Gas_Other �� `'�SLv <br /> WORKDESCRIPTION ' I ��R^ � �� <br /> NCN i���+v��+-cT �/rh �,vs;n.��c�-r��t� �«��r�'.�'}�' , � .: ' � <br /> �� T�i � ,�v� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FlXTURE OFl ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub . Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal (� Gas lirepiace �� <br /> Dishwasher � Yl _ Gas range <br /> Clothes washer � _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) _ Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> �rinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Greasetrap _ Wcodstove <br /> Roof drains Olher <br /> Other — -- <br /> CffY OF EVERET�LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceritify that I have read and examined ihis application and know the same to be We and correct. All provisions of laws and <br /> o�dinaces governing Ihis type of work will be complied wilh whelher specified herein or noL The granling ol a permit dces not presume <br /> lo give authority to violate or cancei ihe provision of any other state or local law regulating construc�ion or Ihe pedortnance of <br /> construcfiorrTh-a1���m authorized by the ownor of this property to peAorm ihe work for which application is made and I comply with the <br /> Statc Contraaors Caw 18.27 RCW and 296200 WAC. <br /> -i�S�y�T-t�r�t�--, �D ['--'--Y"--• <br /> Sig a o cf edCantractor/Au�horized Ac�ent Date �-. <br /> ���, � <br />