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�CRMIT APPLICATIO`N <br /> CITY OF EVERETT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPIICATIONS ARE ACCHpTED FROM 8 AM TO 4 PM <br /> SITE ADDRE33 PARCEL TAIC I.D.A PERMIT# <br /> 1No1 + o�-t cooc�,c�►oo rno�oi -os� <br /> lEG LOTNO.� I� BLocK 7RACT <br /> DESC. <br /> A�DRE CI 21 PNONE ��25'� <br /> �� ��vn�- �,Q �9yoi ���`�w. S� a�.U-,�,°r�°3� ���o-qa4a <br /> TENANTNAYE CONTACTFORPERMR PHONE <br /> FF D�� L, P � � P.�,�,r►J �«vA� y�zs 3� -woc> <br /> CON7FtACTDR �'�N`�li�_ ApDRE&5 3"i'�p �j CtTY21P PHON@ <br /> TNISTLR_ 5?Y�� 2Clo'-725'$�$ <br /> CONTR LICHNSE N ��,��� �a� �,Wa,. <br /> aana�3s� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �A]�.�T1F�ll.v� - I v Elechic _Gas_Other I IZ � �'3 . IO�J � <br /> WORK DE4CRIPTON <br /> V�I�TIr�C� ^1�.1,J �,ousr¢uu-torJ `IM�-'T�F+Q�►H,�u-( <br /> PLUMB MEC ANICAL <br /> NO� TYPE OF FlXTURE OR REM NO. 7YPG OF FD(1'UR�OR ITEM <br /> To1et PJC–air hsndling units <br /> � La a o�(wnah Daein) _ Gas�d �a^r systoms <br /> — PP 9 <br /> _ ShOwar Watcnc�2tor <br /> _ fOtehen sink&disposal �, Gas tireplace <br /> Dl�hwashor Gas ranga <br /> = Cbthes washer � Cbthas dryer <br /> Water heater Renge hood <br /> _ Sink(servicelbarlmop/alc.) ,]�, Exheust fan <br /> _ Backflow prcventer Heat pump <br /> _ Urinal � UnR Aeater <br /> Drinking FouMain goi�� <br /> _ Floordrain ay_ Refiqeratbn <br /> ._ Orces�trap Woodstove <br /> Roaf dr�ins '— p�e, <br /> Olher -- <br /> CITY OF EVERETT 40CAL 8ALE9 TAX COD�Ig 3'I05 <br /> 1 horeby ceridfy that I have read entl exemined this appNc�tlon and know the same to be trua end corrcct Atl orovtatona of�aws end <br /> ordinecea poveminp thls rype ot work wlll be wmptlW wifh w�o1Mr epecified hereln or noL The grenting of a pertnft tlo09 not pr9aumo <br /> to ylve authori lo vbiate or car;cwl the provnion of any ofher slate or locat law reguletlnp eonstruc6on or the partormence of <br /> eonsUuction at I am a o ed by the owner of thls prop�rty to perfo.�fhe wprk 1or whloh appllntlon is neda end I comply wlth ihe <br /> State Con rs Lew 7 CW and 296,200 WAC. <br /> .ti—� � (p p <br /> Si�ne e a er n cror Authonze qent a�o � <br /> �Q�o� . <br /> �3 <br /> � <br />