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r -� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-885�—www.everettwa.org <br /> APPLIrATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS FARCELTA:(I.D.# p 11NTg� <br /> �-c.;� � Gl��„«n���� �kc c� �.�:c��,�< -��,� I �'Ja� v� <br /> LEGA lOTNO. BLOCK TRACTOASUHDIVIS'OIII <br /> DESC. .�S E Vt.{e(L (�e'/i� <br /> OWNER ADDRESS —LITY/LP PHONE ,,�5 3�3-icr�• <br /> 17Ci�i�r.� a.�d L�NC� � [ /�sci� G-7L`7 �3e��S/��� �- /�� � C�r'i�C'{� ,CL '!J `��:2lJ � <br /> TENANTNAIAE I CONTACTPORPERMIT PHONE cf,�S-3S.3�-YL��C Z <br /> �/)C))C. '��Ei)l)A ���'�Sfv 1 E-AIAIL /�,7�iYi. .IL'���2/"�C:i .ih"( <br /> C-7. CL� . ['.n-lif�)ri�[� �,._ _ C�� L �c: i1L ,C�_'fI y.�5'.jc�F� `/l�r� C�- <br /> cor�rn.uceNse a <br /> fG�LnTL= :�- yyl�ii �/.�5--35�-4Y9.^ <br /> USE OF BIIILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Vl�C<1ii'T Electric _Gas�Other �'�•��p ti'.'3�7C'C'. �� <br /> WORK DESCRIP'iION . <br /> F��'�)�O/iFic'�� Of I)NJ1C .Y.lal Z 6tetUL:-:Illi//!'J . <br /> . • V <br /> ��:•�7vLS �iri..(il>!I Lc.1,C C/<r�) [:�J .�.�:2'. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEN NO. TYPE OF FlXTLRE OFi f7EM <br /> ± Toiiet AIC–air handling units <br /> � Dathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower i Water heater � <���. <br /> r Kitchen sink 8 diepos�l Gas tireplace � <br /> _ Dishwasher � Gasrange ���>>` <br /> _ Clothes washer Clothes dryer'� <br /> Water heater � Range hood <br /> Sink(service/badmop/olc.) � Exhaust fan <br /> Backflow proventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Greaselrap � Woodstovo ja):.. <br /> Rool drains _ Other <br /> Other <br /> CRY OF EVERETf LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know iho same�o be lrue and correcL All provisions ot laws and <br /> ordinaces goveming lhis type of work will bo complied with whether specified herein or not.The granting ol a permit dces not presume <br /> to give aulhoriry to violate or cancel the provislon oi any other stale or local law regulaling cons�ruclion or the perfortnance of <br /> construction,That I am aulhorized by the owner ol this property to pedorm the work for which application is made and I comply with the <br /> State Ca� ors Law 1827 R�W and 296200 WAC. <br /> / / l � / p .�d� <br /> Signatureo nedContractodAuthorizedAgent � Date� <br />