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r � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ( . � ({ _ � ( <br /> SITE P.DDRESS PARCEL TAl(I.D.M PERMIT N <br /> ��='.�, �r�a�{�wn� C��� 39U�7� c3 / � ?' � Oj Do <br /> IEGAI LOT NO. BL CK TRACT OR SUBDIVISION p <br /> DESC. <br /> �WKj ��C�S C✓'v�� 17' L11.'l10 N �DRESS CIiYIZIP PHONE (.�1�` <br /> 3�Gv� 1X 'Grl��w.. �� �V��.>�}} (I�19 ���/ ' � DGJ <br /> TENANT NAME � J CONTACT FOR PER IT PHOj�E�2� <br /> �,�.;,��. ��_u5 �•�'�r7�t���u''`1J�✓�'� i�►-t �•%i�, cY �2v � <br /> R EdAAIL <br /> n ���r <br /> Tyr s�Q�t Fi.�y,or.r S'�5- <yT"5� k��kL•fwl, :.�.iA- <br /> CONTR.IICENSE N ��?��3� >i'22 1�-�� n <br /> S O �G <br /> USE OF UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �^ !�f). ^i/ <br /> /�T�1 M�' _Electric _Gas_Olher yj s <br /> WOI2KDESCRIPTION,�Ng�u- wa� S�Yti cr✓ c.i.��7- ELc��, ' u"�c� 5�9,� cw <br /> �ts7- E�v ,� NcsN •T�cwr1 Dirc'e7'�v.�qC S.yH:, , <br /> Iqe�. c2�(is7'ti4J Siqy�� rc, �� R�,Hou�� <br /> PIUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM N0. TYPE OF FIXTUHE OR ITEM <br /> Toilet !UC-air handling units <br /> OatMub , Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kitchen sink 8 disposal Gas Greplace <br /> _ Dishwasher Gasrange <br /> Clothes was6ar Clothes dryer <br /> Water heater Range hood <br /> Sink(servlce/badmop/etc.) Ezhaust lan <br /> Backflow preventer Heat pump <br /> Urinel Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep _ Woodstove <br /> Rool drains Other <br /> Other <br /> CIiY OF EVERETT LOCAL SALES 7A%CODE IS 3705 <br /> II hereby certily that I have read and e�camined this applicalian and know the same to be true and corred. All provisions of laws and <br /> ordinances governing this type ol xrork will be complied with whether spec�fied herein or noL The granting il�pertnit does not presume <br /> to give authonty to violate or wncel the provision ot any other stale or local law regulating construdion or the performance of <br /> construction.That I am authorized by the owner o(this property to pedorm the work for which application is made and I cnmply with the <br /> StatG�ontradorS�Lew 18.27 RCW and 296200 WAC <br /> � %�� '���'��'Z'L`L''I --���t��1� <br /> S�ol Owner ontracbdAuthonzed Agenl � Date <br /> ' �L <br />