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r - � - <br /> P�RMIT APPLICATIdN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -ww�v.everettwa.org <br /> APPLICATIONg ARE ACCEPTED FROM 8 AM TO 4 PM /�,� �-7�O � <br /> SITE ADDRESS PARCEL TNi I.D.A' � P�MIT# <br /> ,j� ' �� o ! ,�';Z/2' �� <br /> LEGAI' LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC� <br /> OWNER ADDRESS CITY2IP pHONE <br /> TENANT NAME �Z (L,/ CONTACT FOR PERMIT PNONE <br /> '� C E-MAIL <br /> � �— � <br /> CONTR.LICENSE p <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRIGE OF WORK <br /> Eloctric Gas Other <br /> WORK DESCRIPTION � <br /> ,��C��Ic�t �:1.�',��� �J2QL.tJ ,�d,lrl�t�.,�GLCL <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl A/C–air handling unils <br /> � Balhtub Forcod air cyslems <br /> � Lava�ory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitr,hen sink 8 disposal Gas(ireplace <br /> Dishwashur Gas range <br /> Clolhes washer � Clothes dryor <br /> � Water heater �t.�7� {��-)�L' _ Range hood <br /> Sink (serviceNar/mop/etc.) Exhaust(an <br /> � BackP�w preventer Heat pump <br /> Urinal Unit hoater <br /> Drinkin9 Fountain Boiler <br /> Floor drain Relrigeralion <br /> Greaso tra{i Woodstove <br /> Roof drains Other <br /> Oth�r <br /> CITY OP EVERETT LOCAL SALE9 T/U(CODE IS�105 <br /> I hereby cerilify Ihat I hav�read anA oxamined Ihis applicalion and know ihe same lo be lrue and correcl. All provisions ol laws and <br /> ordinaces goveming Uiis lype ol work will be complied wilh wholher spctcilied herein or not The granting ol a permil does nol presume <br /> � to give aulhorily t� violal�or cancel the prcvisinn of any other state or local law regulating construclion or the peAormance of <br /> � r,onsiruc�ion. Thal I am aulhorized by Ihe owner ol lhis proporty to pertorm ihe work lor which apptication Is made and I wmply wilh ihe <br /> ISlatc CoN�.�ctors Law 18.27 RCW and 2�J6.200 WAC. <br /> ��� �_� /Z�i7/= � <br /> � naWro ol O dContrac�or/Aulhorized Agenl Dale <br />