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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8657 -www.everettwa.org <br /> AppLICAT10N5 ARE ACCEPTED FROM e AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX t.D.R PE�T� � <br /> 20�0 ; ��� v��� p�`i3 R 1 -, > o i ��a S O o '-� <br /> LE LOTNO. BLOCK TRAGT <br /> DESC. <br /> OWNER AODRESS CITYRIP PHONE <br /> �.�-�� O'F �ivfv �l-� 3�-oD Cs' cl2v `'�r45-1��Zviv�}l `�f 7��a� ��ir5� <�S�- 8`�ID <br /> TENANTNAME CONTACT FOR VEIWR � <br /> �L_J£. it� 'Lo.�C�tivc`��. I �z''\ �'��rSoL � �I2S�.3`l�1 -�U`{�-1 <br /> CONTRACTOR ADDRESS C�� � CN�I <br /> A�IIo Wei•;�, S�,t �lE��'c 1-�d(h�a��1�c�, S•�;teZC� GM2sl 34y-S <br /> M�wnee, �(8�15 <br /> coHrn.uco+se� f\P01 � N L -U4ti-u(J <br /> USE OF BUILDING I HEAT SW RCE I CONTRACT PRICE OF WORK <br /> n � n_� <br /> LJ'rV�N1�'i.�'C��t.� _Electtic _Gas_O�he� :X � i ��.�� <br /> WORK DESCRIPTION <br /> kti�S�z �� C� � i �lv�v�i✓�z.1'4l ��v�c�t�v� S�«� ,� <br /> PLUMBING MECHANICAL <br /> NO. T'PE OF FlXTURE OR ITEM NO. TYPE OF Fl%T1RE OR REM <br /> Tdlel /UC–air handling unils <br /> — ����� _ Forced a'rc systems <br /> Lavatorylwash basin) _ �5 P�P��9 <br /> Shower Water healer <br /> Ki�chen sink&disposal _ �g fireW� <br /> Dishwasher �s�� . <br /> Clothes washer �0��dry� <br /> Laundry Vay _ Ren9a hood <br /> Sink(servicelbarlmopletc.) _ Exheusl fan <br /> Badcflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinkirg Fa:ntain _ Boiler <br /> Floor drein Re(rigeration <br /> Grease Irap _ Woodstrne <br /> Roof d2ins 0�� <br /> Othar <br /> cm oF�re�r�ocn�swes r�x cooe is s�os <br /> I hereby ceritify Ual 1 have read and ezamined this appFcalion and know Ihe sama lo be lrua and correct. NI provisims of laws anA <br /> adinaces goveming Ihis type o(work will be compied wiM whether spedfied herein a raL The grantirg af a permit does nol pasurt�e <br /> to give aulhoriry lo violale or cancel lhe provisim of any other state or loml law regulaling oonstruction a tl�e performance of <br /> consWctbn.That I am auttwrized Ly the owner of this pioperty lo periorm the work ta which application is made and 1 comply with the <br /> State Contradors Law 18.27 RCW arxf 296.200 WAC. <br /> ������� �_�� � � — aL�C—D� <br /> t�— <br /> Sign ure ol OwnerlConiractalAuthonzed Agenl Dale <br /> � L <br />