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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa org <br /> L��p uT�`"� ��"/ APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM �/p 7/O �J <br /> �1TE ADDRESS PARCEL TAl(I.D.N ERMIT N <br /> .�.ra r l�`sr c,9s,wo ,e�Rr� ���So / oo w2 Soo �05- bi c'� <br /> LEGA LOT NO. BLOCK TRACT QR SUBDIVISION M <br /> DESC. U'.2 QO.� <br /> OWNER ADDRESS CITY2IP PHONE y 5- ' <br /> 3y9 <br /> �v(�� Z/.��. � U7ES�C1�S�NU �cL� 7 G l.�r�]' Cc�A' 9�� 12� <br /> TENANT NAME CONTACT FOR PERMIT PNONE �s- 3y y� GG-5S <br /> w J✓ / C �`'�'G f�lXi+l�cc S CITv2t��+a�Ch�A/� G Sl�ZWSlfL` <br /> 1�oi•v�Gvae,� (�S QuJ�I,�/� <br /> CONTR.LICENSE N <br /> USE OF BUILDIN a HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��F/G� �Electric �Ges_Olher I I U� <br /> �---�� <br /> WORK DESCRIPTION <br /> .� - k'ax � unii7s Tw ��� Sce c.r� /'�Ln� <br /> i/�T�L��o,� ��T ��JorL'I� fi�'c S/'e�,v�-<<.c� /1�� G�7G�.�G G2�/��T/�.- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel o NC—air handling units <br /> Bathtub Forced alr systems <br /> Lavalory(wash Lasin) Gas piping <br /> Shower � Water heator <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer _ Clolhes dryer <br /> W alor heater Range hood <br /> Sink�servicelbadmop/ola) _ Exhausl les <br /> BackOow prevonler _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boller <br /> Floor drain Re(ilgeralion <br /> Grease irap _ Woodstove <br /> Rool drains Olher <br /> Other <br /> CITV OF EVERETT LOCAL 8ALE3 TAI(CODE 19�105 <br /> I hero�y ceritify lhal I hnve read and ezamined Ihis application and krwH the same to be true and correct. All provlslons oi lewa and <br /> ordina�es governing Ihis lype ol work will be complled with whelher specified hereln or not.The granling o(a permil does not presume <br /> tn giv�authority lo violale or cancel the provision of any othor stale or local law regulalinp conatrucNon or lhe performence ot <br /> conslruclion.Thal I am aulhori by the owner of this property lo periorm the work(or which applicalion Is made end I comply wilh the <br /> Sta �n?ractors L,�2 CiN and 29G.200 WAC. <br /> �- �-09 <br /> gneture ot n nlrac ��Authori d Agent Cete <br /> __�=_ __ - � � � <br /> _ _ _ - - - - -- <br /> - <br /> � <br />