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• � � <br /> PERMIT APPLICATION <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 /> �(`�ID!D APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM q/��D� <br /> SITE ADDRES PARCEL TAX I.D.iF P T A' <br /> � � �o�y y�'ai�/i�� 9a� � �63�Gb8 <br /> LEGA LOTHO. OCK TFIACTOflSUBDIVISION� <br /> DESC. <br /> WNER r I I ADDRESS GTY�pp pMpryE /4� <br /> A6f(AT 1'C�2 N LcM A�,1 (I'1 371J I ��DAD�/��I ���TE� [—�I �RZO I �'�S-- �Z.S I <br /> iENANTNAME CQNTACTFORP IiONE q2�_ a�S_�� <br /> N /� IMA25/ ��A�,S e-Miu�/�{'carSC�'.I�,��fct�$na(, �J/t.c <br /> �ah�f�t-� -�or (-� umari�� Snol�om�sh C'c,un J <br /> CONTp.UCENSER N JA <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��l D��f 1 1 J��. �-1T�M w S �ElectriBF�! Gas_Other /,s� ��� <br /> WORK DE�SCRIPTIOI. <br /> � K��tl]F.aTiRc- NoMES �u57P,yG��o�-- � ��,, _ „E]�LTi�– — <br /> �� S� 3�ORc�+.� � <br /> . <br /> G CAL <br /> NO. TYPE OF FlXTURE ON IiEM NO. TYPE OF qXTURE OR I7EM <br /> �_ Toilet � A/C—airhandlingunits <br /> 1 Bath!ub / � Forced air systems <br /> � � Lavato��(.iash bas(n) ��� Gas pping <br /> � Shower (-rj-$E.�L'ooM H�IE�I _ Waterheater <br /> _ Kilchen siMc&disposal �ACH NoME Gas fireplace <br /> Dishwasher = Gas range <br /> � Clothes washer � Clothes dryer <br /> � Water heater ,� Ranpe hood <br /> Sink(service�bar/mop/elc.) dL Exhaust tan <br /> � Backllow preventer � Heat pump <br /> Urinal Unit Neatar <br /> Drinking Founlain Boiler <br /> _ Floor drain / Refigerallon � <br /> _ Grease trap V — yy�10Ve <br /> Roof drains Other <br /> _ Other — <br /> y�,��� % 94 s{1 <br /> 1,�'.�'� CRY OF EVERETT LOCK SALES TA7(CODE IS 3105 <br /> I hereby certlity thal I have tead and exam(ned this appiiradon and know tha same to be hue and cortecL All provisions ol laws and <br /> ordinaces governing this type of work will be complied with whether specilied hereln or not.The granting ol a pormit does not presume <br /> to give authority to W,olate or cancel the provision ol any other state or local law repulaNng construction or the peAormance of <br /> construction.Thal I am authorized by the owner of lhis property to peform the work tor which application is made and I comply with ihe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> -�.,�-.e�'`-aJ �/�a/a�� <br /> Sig a e ol Owner/�ntractoUAutlionzed Agent Date <br /> '�� <br />