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� L_ ol -o <br /> P'�I�MIT APPLICATIC,N <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 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITEADDRESS T � RMIT�/ ` <br /> � 1 � C�� �t i, ��/l= _ � � � �'�-�, 1 °Z � D/b <br /> LEGA LOTNO. BLOCK TRACTO � 7,j��OUGOU <br /> DESC. <br /> OWNER AODRESS CITY/ZIP PHONE <br /> ��c �- ��c ��� Sv�1�PSFr.,e,v,fs �3�� �.9-crF��. rl/eve�--�- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> k�G1 l�c�c�.� w�va��S t�Cnlrz�.� ('x�nvr� �l�y�� r�N<k, �yz�)�7�-o`lZ�x�37 <br /> CONTRACTOR AODRE S CITY2IP PHONE <br /> ��`S�O CU�Sk-w��� �\ � ��zs�^,�l-o3Z� <br /> CONTR.LICENSEp 7 ��v nL /.1r\` � L��wa� � �,��9� y� x�37 <br /> \�Sl:SC(1 C1) Q�C2.' 1� �C� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � _ � � _Electnc ,�Gas_Other S g �U <br /> WORKDESCRIPTION �eYti7C)`�C �XI S �t' )✓/� �Gi�'I �� ��O `�'I �� ��'1Si'!?CL I�e GS P` <br /> ��c��a� �� ,,�sti� �., so(U�F��„s (r�i�W � e �,7 �c�.f ��ci��,-2e I �ared �uc���J <br /> 12�e Ca� �'�c v �� Fx�s��,�c.'1 �, h /fis �ec�.c��-e_ d K�,Z �,ve�,l �,v0{- � <br /> �}ll (,.fe.Y1-�C � S �nsTevVlc. N �/�' 'P�u� (� ��-��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> = Lavatory(wash basin) � Gas piping � <br /> Shower Water heater <br /> _ Kilr,hen sink&disposal _ Gas fireplace �,,% <br /> _ Dishwasher Gas range f � �j � <br /> _ Clothes washer Clothes dryer JC� ,p.,! <br /> _ Laundry tray Range hood , �) W � <br /> Sink(service/bar/mop/etc.) Exhaust fan `� <br /> _ Backflow preventer _ Heat pump <br /> i _ Unnal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refriaeration <br /> Grease trap Woodstove <br /> = Roor dra�ns J_ Other pa�w h50%4ti �Co�"� <br /> i = Olher _ —T <br /> I <br /> � CITY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be irue and correct. All provisions of laws and <br /> ordinaces 9overning this type of work will be complied with whether speci(ed herein or not.The granting of a permil does not presume <br /> to give a thonty to violale or cancel the provision of any mher state or local law regulating construction or the performance of <br /> constroc on.That+am anthor�ed by the owner ef ihis property to perform the work for which appiication is made and I comply with ihe <br /> i Stale OtrBctors Law 18 CW and 296,200 VJAC. <br /> � � <br /> � \ . (�-('Z.-9� <br /> Sig at r o�Owner/Contrector�Aut onzed Agent Date <br /> , ��v� <br />