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F'�t�i!" :T APPLICATION <br /> CITY JF E ��itETT PERMIT SERVICES <br /> d200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-6810— FAX 425-257-8857 —www.evereltwa.org �b� <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �jt Da -� <br /> S�E�DRESS / , /` U � C6LTA�l( D.#oO E MITtt _ <br /> �� � �p�� 5 � la �ot C <br /> LEGAL LOTNO. BLOCY. TRACT <br /> DESC. <br /> OWNER A-DIDRESS CIiY21P PHONE y�5- <br /> ._'joc�1.,�� � �G� � � �{ �� � C11F'S711�1'�" 5'F ��PfP�� �S�OJ 303 -�y.f�} <br /> TENANT NA`AE CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> � ��U�2� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S �� _Eloctric _Gas_Other <br /> WORK DESCRIPTIO /� [�/ �� ��J / i ` ,� <br /> �rl/:t� ✓I[-l ��� �� �C� (�0�-�'`J� �L- `�zi�- YI.C`L: <br /> / <br /> 1 / <br /> <����' �'�'•� � ��`���`' � � . ' �.�'" <br /> �% PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water hoater <br /> � Kilchen sink 8 disposal Gas fueplato <br /> _L_ Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray � Rango hood <br /> Sink (scrvico/bar/mop/etc.) _ Exhaust fan <br /> BackOow proventer _ Heat pump <br /> Urinal � Unit heater <br /> Drinking Founlain _ Boller <br /> Floor drain Refrigeration <br /> Groas�.irap Woods�ove <br /> Roof drains Olhor <br /> Other <br /> CITY OF EVERETT LOGAL SALES T/U!CODE IS 7705 <br /> I heroby cerility Ihat I have read and examined Ihis applicalion and know Iho same to be truo end correcl. All provisions ol laws and <br /> ordinacos goveming this lype ol work will be complied wilh N�hethor specified herein or not.The granting of a permit does not presume <br /> to�ivo authoriry lo violate or canr,ol the provision of any olhor slato or local law regulating consWction or lhe peAortnance of <br /> construction.Tha�I am authorized by lhe owner of this proparty to porform Iho vrork for which application is made and I comply with the <br />� Slalo Coniractors Law 1827 RCW and 296.200 WAC. <br /> 1/ /t. 1 � L � 2 L[ ��?}' <br /> 9ig�re o�f 6c .r/ ontrac nlhonzod Agent ate <br /> `;z <br />