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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.everethv�.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAJ(I.D.# P RMIT <br /> v`�i5i5 " I l f1.�fl.11L, � ���i 1 1 5 . - -�l� � 4 - � � <br /> LEGA LOTNO. � BLOCK TRACT <br /> DESC. _� �� G- � <br /> V <br /> ONRlER AODRESS CIIYlTJP PHONE <br /> � G{�:l>>�.l'�`aiJ'�- 1'IYL�w::�.���rwn'1��G. <br /> _�CIIY., Cr�`��' f�an`ht(�,f� 3u��C• �1.�,�lt,�p`' l,li��*� �C[; r3i�l4�t.tS.. l.lA ��1 �,•�' <br /> TENANT AME CONTACT FOR PERMIT �_ PHONE � <br /> �u �ctuA.. ��onJ �� ,1�c. Y�'tc�.,- �� ��u,l T�,kn�hu� ��'� lo I �g <br /> CONTRACTOR ADDRESS CL ZP PNONE <br /> 1;��,-���u,, 4r�fiuc.�tiu-, l.�L �. '3t�{ ss��9 �-,Lv uKi p <br /> CONTR.UCEN E�t ��'-j 7j ((!�p�- ���C( <br /> U N�l>C( nrv��aC `i��y._��I�� �, <br /> USE O�G I — HEAT SOURCE I �NT�RICE OF WORK <br /> r Etedrie Gas Olher ` � <br /> WORK -ESCRIPTION <br /> �i,ic �la rh�11� �tXUlS, Fjui�tl n�e�� +arfi'�1� �{iC[S �1 `�tw�sh l.iitL�lr� <br /> � � ��y � <br /> �f:C'�l'i � � a Fit:.,: \z. � � { ' Q1.i � ` � 't�.� la�t1.Q..�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYP[OF FIXTURE OR ITEM <br /> _ Toilet AIC–air handling units <br /> _ BathWb Forcedairsystems <br /> _ Lavalory(wash basin) Gas piping <br />, _ Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas rangc <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/ela) Exhausl fan <br /> _ Backflewpreven�er Healpump <br /> _ Urinal Unit hcater <br /> Drinking Founlain Boiler <br /> _ Floordrain Refrigeralion <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 1105 <br /> I hereby centify lhal I have read and examined Uiis application and know the same�o be true and correct. All provisions of laws and <br /> ardinaces goveming ihis type of work will be complied wilh whether specifed herein or not.The granling of a pertnit does not presume <br /> to give authonty to violate or cancet the provision ol any other state or local law regulaling consWdion or the peAortnance of <br /> construdion.That I am a thodzed by the owner o(this property to pertortn lhe work for wiiich application is made and I compiy with the <br /> State C ors L w . 7 CW and 25v200 W4C. <br /> a , �t-� . <br /> Sgn Owner/ConiradodAulhonzedAgent Date � <br /> �IZ <br />