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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 96201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FHOM 8 AM TO 4 PM ����-p;L 3 <br /> "al <br /> SITE ADORESS VARCEL TAX 1.0.7i PERMIT# ,.-r;5,�� <br /> , � � ; , -� E vlrt#� ue 5 3 �qE��z ri� 3 cc� - <br /> LEGA LOT NO. BLOCK TRACT Ofl SWBDIVISION# ,p f <br /> DESC. •" .� .— < , _�: � � �f A. l4� VQ , 12 / . / Z <br /> OWNER ADDflESS CITY2IP PNONE <br /> , y�,.��� Z,�r FS���;��,, P�k �� �_ �n,�= 9�zvy y��� z�Z - z�,� <br /> , <br /> TENANTNAME COMACTFORPEH{M.IT PMONE �Z� ���, ���� <br /> TP7 D �: k-Q /�1 i F'Izn ar e.�a� <br /> I" I�fJfZ� �/USh�f.4A 11-(k�Ll� l�Cl�� /Qt�Q(1KT '�R . JVI �--� EYZ/�c�l yzti'pZIZ' <br /> CONTR.LICENSE N " z y /V <br /> m /ET� �Pq3y�k �r�. (�/Iz/il <br /> USE OF BUILDING HEAT SOURCE CONTHACT PRICE OF WORK <br /> �.�j�f /��LQ _Eleciric �Gas_Othar 2 I{ �� <br /> ! � <br /> WORK DESCRIPTION � _ .. .-}- �_� nl„_ _ „ ��_ ,./_ � V�`.�� Z�L,/ <br /> .rvii.lT.►✓� �..�1' Rl,..c�_._.��� / <br /> ��p(� S�wa�'Q � � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTUHE OH ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet —� A/C-air handling units <br /> BathNb � � Forced air systems <br /> � Lava�ory(wash ba�inl Gas piping ��J <br /> Shewer Water heater � <br /> � Kitchen sink&disposal y _ Gas fireplace <br /> Dishwasher i� �' _ Gas range �.�� <br /> Clothes washer �� � Clothes dryer � <br /> _ Water heater ; ��� rii � Range hood <br /> _ Sink(service/bar/rqop/etc.) �' pv� Exhaust fan <br /> _ Backflow prever}t�r � _ Heat pump <br /> Urinal / ' Unit heater <br /> Drinking Foun��n . Boiler <br /> _ Floor drain % Refrigera�ion <br /> _ Greasetrap� Woodstove �1 �� <br /> _ Roof draic�A � _�� Other_ �' t7 - G l�'� i�-( <br /> _ Other� _ rs �- I <br /> (�J-�C/�/) v <br /> CITV OF EVERETT LOChL SALES TAl(CODE IS 3105 <br /> I hereby ce�itity that I have read and examined this application and know the same to be true and correct Ail provisions of laws aM <br /> ordinaces governing ihis type ot work will be complied with whether specified herein or not.The granting of a permit 4oes not presume <br /> to give auilority to violate or cancel the provision of any other state or local law regulating consiruction or the performance of <br /> consiruction.That I am thorized by the owner of this proaerty to perform the work for which application is made and I comply with the <br /> State Contrecror aw 27 FC an . 200 C. <br /> %�— / _ c�� <br /> Signatme of ned on ac odAutho ed Agent Date � <br /> /� <br /> i <br />