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�ERMIT APPLICATI�N <br /> CITY OF EVERETT FERMIT SERVICES I <br /> 3200 CEDAR S7REET, EVERETT, WA?8201 <br /> 425-257-8810-FAX 425-257-8857-www.evereriw2.org <br /> APPUCATtONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SfTE ADDR�SS PARCEL TAI(I.D.N PERMIT A <br /> 40l a c��o� Po �o� -oia <br /> LEGAL LOTNO.� �� BLOCK TRACT <br /> DESC. <br /> � Ofl� "<. I IZ ONE u2s� <br /> �F f��v��Wr �,f'. l9yoi 41�r� .� w. � � ��,°�3� te.�o 9ay� <br /> TENANT NAME CONTACT POR P6RMIT PHONE <br /> F� ���n+� l.. P � P.�,��J ���,vA� t-tzs 3Zs -v-tm <br /> CONTRACTOR 11 e...�_ �a�V I� ADDRESS CfTY21P PHONE <br /> l�w•rn1 �201C3 WOOo'S►xF1 f�0 N� <br /> cormi.��c�r+sesON�W�{'}1[ fq(oB6 ��Nuu.R- q80YL �LS- �l- YSSS` <br /> USE OF BUILDING HEA790URCE I CONTRACT PRICB OF WORK <br /> �/�(J�`rj ����7/�' v EleeMe ,_Gas_Olher <br /> WORK DESCRIpTION I <br /> "�1.t31tti(�..ytA.�Co, ��.V.� �JOA�Ti7.�1C.�'loh� �IMAII-YI�?Y1��u-( <br /> PLUMB ME ANICAL <br /> NO. 7YPE OF FU(NRE OR ITEM NO. TYOE OF FIXTURE OR ITEM <br /> Totiet A!C—eir hondllnp units <br /> Bethtub � Forced air eystems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Waterheatar <br /> � Kitchen sink 8 dispoaal = Gas ftreplaee <br /> Dishwesher Gas range <br /> Clolhes waSher Clathes d��er <br /> Water heeto� Range hood <br /> _ S��k(serviceJbar/mopletc.) Exhaustfan <br /> BacMlowprevsntor ` Heatpump <br /> � Urinal _ Untt heater <br /> _ Ddnkleg Fountain _ BoUer <br /> Floor drain Refrigeratlon <br /> , Groasetrap Woodslove <br /> Roof dralns Olher <br /> i Othor <br /> GITY OF EVERETT LOCAL 9ALE5 TAX COOE{S 7t05 <br /> �hereby ceritify that 1 haw road end exomined Mis applicaUon�nd k�ow ihe same 10 bc true and correct. AI�provlslons ot laws and <br /> ordlnac�a govemlrg tnts type ot woAc wlll be complied with whelher spedfled noreln or not.The g2nting of a pemtit d0es not prosuma <br /> to g'rre aulhort to vfolate or canoel the provision of any other state or loCel law rogulating constructian or tha pertormance of <br /> constructlon at I om a o ad by the ownor of this property to pertprtn the work for which application is made and I comply wlth the <br /> Sfats Con ors Law 1 CW md 296200 WAC. <br /> ./�--� � (p (� (p \,4 I <br /> �O�o a ner n ctor u ze gent a�e O <br /> �� <br />