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-. . [ . . . . �� '�: .;Yl i <br /> PERMIT APPLlCATION <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STRE[T, EVGRETT, WA 98201 <br /> 425-257-p810— FAX 425-257-8857—wvr�w.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM <br /> SITG ADDRESS PARCEL 7AX I.D.fi I PERMIT q . <br /> 1�to 1�-0 �Je.' {�t � i , - � �; <br /> LECAI LOT N0. GLOCK THACT OR SUBDIVISION W <br /> U@SC. <br /> UWNER AODfiESS CIN21P PHONE <br /> ��mer�ic,o C�ue,�rrc,r�c� �c�.ntie.. �{-�S ?�a�. 5� �o <br /> T[NANT NAldE I CONTACT FDR P[RIdR PHDNE <br /> EMNL <br /> �N� -Hn9 ��� 1 ,�15 13roc�uaa�.� Eiexe_.t� 4�5 2�� �(��O <br /> �o��rvii�Ns��a°+5,2�4° �1 s�a�a � <br /> USE OF BUIL�INO � HEAT SOUHCE � CONTRACT f'RICE OF WORK <br /> _Eleciric �Gas Olhor <br /> �� — { �w <br /> W ORK DESCHIPTION <br /> r~�Iac.� r,c� �Oa.S �c'urv�c.c�',�..� <br /> PLUMBING MECHANICAL <br /> NO. TYP�OF FI%TURE Ofl IT[h1 NO. NPE OF FIXTURE OH ITEI�A <br /> Toil�� A/C—air handling units <br /> ^ �alhlub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> ShowCr ' Water heatar <br /> Kltchen Sink&disposal Gas Ilreplaca <br /> Dishwasher Gasrange <br /> � CIuU�os washer � Clolhys drydr <br /> Wa1er h0ater Range hoed <br /> Sink(service/bar/mop/etc.) Sxhausi inn <br /> Backllow preventer Heat pump <br /> Urinal � Unit heater <br /> Drir�king Fountam Boiler <br /> _ Floortlrain Acfrlgeration <br /> Greaso irap Waodsl vy ,. e � <br /> _ Ronf drains �_ Other� S r t,dr <br /> Ofher <br /> i <br /> qTY DF EVFRETT LOCAL 9ALES Ty(CODE IS 9103 <br /> I hr.rrby centily that I have read and axamined�his application antl know the same�o bd truo and correa. All provisions ot iaws und <br /> ordinaces govarning this type ol work wi�i ho ccmplied wlih whethar spocdied hemi!�or noL 7he qranting of a permit dc --;not presume <br /> to give authority lo violate or cnncel ihe provision of any other state or local law repulaiing construdior.or the pedonr. .v of <br /> construciion. That I am authorized by ihe ow�er of Ihis ptopeity lo pOdonn the work for whith application is made and I comply with the <br /> Slate Cumraclor^,La�v 1f3.27 RCW and 290200 WAC. <br /> ��bb 1�,,��+•S q �g• I 1 <br /> Sflnat re of Owner/ ontracror/Aulhorzetl Ac�ont D2le <br />