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ERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE7, EVERETT, WA 98201 <br /> �������,� 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> i <br /> F�VOIO APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PI11 I <br /> SITE ADURESS PARCEL T/U(I.D.M PERMIT M <br /> iyol � et�K. c�too Nt o�or-o� <br /> LEO LOTNO. BIOCK TRACT <br /> DESC. �I�� <br /> qpD CITY2IP ONE �,.�ZS•, <br /> �F' (.����nahn- i-,� Iq�1o1 4��`au�w. S�x� � �u►�,°�o3co _ce-to-9��� <br /> TENANT NAME CONTACT FOR PERMIT PMONE <br /> FF Drur,�oPvn�r� L P I P-�tk►.1 �i�vA� Ltz� 37.�d -a-io� <br /> CONTRACTORr�rn�1mS � MDRE55���� CIT�'RIP VNONE <br /> 2zo-"-.s� �� qs3v`-�3 �~ <br /> corrne.uc�Nae� � 3`Z-�13� <br /> YVl�rt-2°„�C 1`1'l C(�, 1mWuFWrfL'tr�a4.�c�. <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRI�CE OF WORK <br /> �{�J[j���'yr,J(fi„^ { v ElecMc _Ges�Othor � �7 �• <br /> WORK DESCRIPTION <br /> u V�� �- ��W �AIJST1LuU�tOh1 11rn,l�TIG41V�tU-� <br /> � � <br /> PLUMBING HANICAL <br /> Np, 7vpe oF FIXnIRF,OR ii�M NO. TYPE OF F�XTURE OR tTEM <br /> Tollet AIC—air h�ndling units <br /> _ 68lhtub _ Foreedalrs}�stoms <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heekr <br /> Kilehen sink 8 dispossl _ Gas fireplacQ <br /> Dishwasher Gas rengr <br /> Clothes waeher Clothes oryer <br /> Waferhealer � Ranpehood <br /> i Sink(service/berlmop/etc.) _ E�chaust hn <br /> � Beckflow preventer Heat pump <br /> Udnal ',� Unit heater <br /> Drinkinp Fount�in Boiler <br /> Floordraln r Rafri9eration <br /> r Grease trap _ Wootlstove <br /> Roof drains Olher <br /> � Other <br /> CI7Y OF FVERETT LOCAl5ALE5 TAX CODE IS J705 <br /> I hercby ceritify that I have read and examined this applicatlon antl know the same to be truc and correcl. Atl provislons of Iavn end <br /> ordinaces goveming tM�s typ@;r worK wlll be compliod wiq�whelher specfiod herein or not.The grenting of a portnit does not prpcume <br /> to gHa authori to violaro or cancel lho provlsion of any othor stale or local laK�regulatlng�onshuctlon or the porformance of <br /> construction at t em a o ed by the ownar ot this pmperty m parrorm Me work tor whieh xpplicaflon is mede and I wmply with the <br /> Stete Con on L�w 1 CW and 296.200 WAC, <br /> r,-'---- � e a 4� <br /> S�gna e o er on eror onze perd ate <br /> O�\ <br />