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—� <br /> P�RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEC�AR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereltwa.org <br /> APPUCATWNS ARE ACCEPTED FROM 8 AM TO 4 PM �f .— a---O� <br /> SITE AIIDRESS PARCEL TAX I.D.N PERMIT M <br /> ` r>� b� Cca' i�v, i7c� �I Z � — <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> C/a s/I �'L ���„ ��tc��� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E�NI/UL <br /> �;����1� 1;,� i>>�Yf ��� � �yosS� 31� SL `c� 2Z �CS�`-('7 <br /> CONTR.LICENSE p ��,c��.i I: f'1� �%)J �0 1< a W �1 � 'J'�'�I Z <br /> e� � <br /> USE OF BI�ILDING � — HEAT SOURCE CONTRACT PRICE OF WORK <br /> . aG <br /> Eloclric _Gas_Olher I .��,� <br /> _1 <br /> Y/ORK DESCRIPTION <br /> L+�- �oc E�,,-� �.�Uy)�rc',1 Jir+ �Y"/��'.�� /� �l U(rC <br /> PLUMBING MECHANICAL <br /> N0. I TYPE OF FI�'TURE OR ITEM — NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathlub Forcod air systems <br /> --- L�vatory(wash 1�3sin) _ Gas piping <br /> Shower ___ Water hoaler <br /> Kilchen sink 8 disposal __ Gas lireplace <br /> Uishw�shor Gas rango <br /> Clothes washcr _ Clothes dryor , <br /> Walor hralcr Range hood <br /> Sink (seriiceNarlmoplo�c.) _ Exhausl fan <br /> I _ Oackflow prevenler = Hoat pump <br /> Urinal Unit healor � <br /> � Drinking Founlain Boilar <br /> Floor drain _ Relrigeration '�, �_ � <br /> — Graase Irap _ Woodslove . � <br /> Rool drains Olher_ <br /> Othar <br /> CITV OF EVERET?LOCAL SALES TN(CODE IS 7105 <br /> I hereby ceritily that I have read and exam�ned lhis applic2tion and know the same lo be true and corcecl. All provisions oi laws and <br /> urdinacos c�overning Ihis lype of work will bo comp�ied wilh whelhor spacifiod harein or nol.The granting of a pormit does nol presume <br /> to givc�aulhonry lo violale or can;,ol tho provision of any other stale or local law regulaling cunsWction or the pednrmance o( <br /> conslruclion. Thal I am aulhorized by lhe owner of Ihis propohy to perlorm Ihe work for which applicalion Is made and I comply with Ihe <br /> Slalc Contrar,Wrs LaH� 18.27 RCW and 296.2Q0 WAC. ) <br /> ..,i <br /> / �'' J � r�l <br /> I Si�na�uro o(Owner/ .oMraclor/Ault�orized Agonl Date � ' ., <br /> J <br />