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� .r � .r i <br /> I <br /> PEkMIT APPLICATION (j ! <br /> CITY OF EVERETT PERMIT SERVICES r' ,�jd I i <br /> 3200 C[DAR a?RFET, EVERETT,WA 98201 �1�i � <br /> 425-257-8810-FNC 426 257-8857-vrww.everetlwa.org ` /�VV � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 704 PM •DEBIT 8 C4EDIT CARDS ARE NOT ACCEPTED <br /> I <br /> SIiEAODRESS � � PAR EL'"AXI.D.# PERI171T# � <br /> /40� M�RR�+L� cREEl� U6 `�J (� (�`v l D O I .� S ; <br /> LE3A �o. . D��Kr T��T �v�no 00o c�zoo — � <br /> DESG � <br /> OWt1ER pDDRESS CRYITJP PHONE � <br /> FF�!�l`�1�G.P. s�/o M�P�bvsE sl�., sur7�Zcn, s�rvtrL�o c,+ 9a�t� j <br /> T[NANT NAME CONTACT FOR PERM111i � PNONE <br /> FF ZB�LA'�Ms/�/G.P. I � �E�/�LO�y�/Yr' L.P. 858 4�7 Zlz3 i <br /> CONTRACTOR ADDRE3S CITYZP PHONF. j <br /> t <br /> W NiR.LICENSE d I <br /> USE OF BUILDINO HEAT SOURCE �yCOlITRACT PRICE OF WORK I <br /> A•��/��1�/ �L'17//�`'�� �EIeG�ic �Gas_OO�n� I T�'1,O OGY��MD. � '� � <br /> / / � <br /> WORK DESCRIPTION �� <br /> /8-3 5'Tcl�`f hJ'71?�'TMIE/►'r PI.Yt1a'N65 , ' � <br /> �� � ^�' �� <br /> i <br /> %�=-- -- I <br /> PLUMBING MECHANICAL <br /> � <br /> . NO. TVf+E OF FIXTURE OR ITEM NO. iYPE OF FIXTURE OR ITEM <br /> — I <br /> Tailet • NC–air hnndling units i <br /> Bathlub• Forcad nir systems <br /> Lavatory(wash basin) � Gas pping <br /> Shower �fL Welerheater• � <br /> .y��T IGtchen sink&disDosal �,.���� Gas tireplace /� <br /> (J� Dishwasher• � Gas 2nge � <br /> '�Q(C Ciottx�washer• Clothes dryer• � <br /> „^, Laundry tray ,.�'�� � � Range hood • ; <br /> , Sink(service/b8Flmoyela) 9('(R Exhaust fan• i <br /> _ OackflowpreNenter Heatpump I <br /> Urinai ' �� Unit hea � <br /> _ �rinkin§Founlain Boiler � <br /> rloor�drain _ Ref' eralion � <br /> Grease trap � � odstove � <br /> _,Roof drains - lhcr ; <br /> : Othor <br /> — — i <br /> - - ( <br /> + <br /> . CITYOFEVERETTLOCALSALESTAXCO�EIS9106 � <br /> --- 1 <br /> I hereby carilify Ihat i have read and oxamined Ihis applicalion and know Ihe same l0 6e We and correcL All provisions of laws snd <br /> ordinaces governing Ihis ty�.e of vrork will 6o complied N4th whetFcr spedfied herein or not.The grantlng of a pertril does not preaume <br /> to give authority to violate or cancel Iho provision of any ofher state or local law regulating consWcfion or the pedonnence ol <br /> conslnic' t I am aulhonzed by the owner of lhis proparty to oedorm the woiK for which application is made and I wmply wilF�the <br /> Stot ontracto Ln . a. 2�3.200 WAC. <br /> ��. 5-/C-Oy <br /> Signa ure o e ontractod ut orized Agent ate - <br /> f�/r�M./tL�+�1 s .Nr� _ `� <br />