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, .� i <br /> , <br /> ; <br /> I <br /> PERMIT APPLICATION `'1/ <br /> CITY OF EVERETT i�ERMIT SERVICES �' ' <br /> 3700 CEDAR STREET, EVERETl',N.'A 98201 � <br /> 425-257-8810—FNC 425-25'-8857—www.evc�e flwa.ory y�� ! <br /> APPLICATN43 ARE ACCEPTED FROM 8 AM TC 4 P'4 -DEBIT w .',EuIT CARDS ARE NOT ACCEPTED <br /> . j <br /> SIiEADORESS -�� �� PAR ELTAXI.D.# PERh71T# � <br /> i�ot n��,w�� c�i� t�r L�6 �7�lZ�,D,�, /YY� ('Xn ( ��D I '1� ; <br /> LEGA LO7N0. B OCK TRACT OU�J"1 /O �� D�ZOd I <br /> DESG � <br /> i <br /> OWNFR AODRF.$$ CINIZIP PHONE � <br /> F�7�EV�l�f)N�N7�G.P. 5570 MEy�Li+bt�EL1Q• S1i/7E�ZDo, s�bVA'� U 92/L j <br /> T[NANiNAME CON7AC7FORPERMIT � PHONE i <br /> FF ZSI�GA"M6KT G.P. I � DEf/���1�J►? G.P. b58�7 2/z3 <br /> CONTRACTOR ADDRE3$ CIiY21P PHONE j <br /> CONTH.LICENSE d i <br /> i <br /> USE OF BUILAINO HEAT 30URCE CONTRACi PRICE OF WORK � <br /> f{-f��jyE.�r�iy'(�//�(�.� �Electric__Gas_ouier I�.p�D��O. BD �' � <br /> WORH DESCRIP710N � <br /> /8-3 STcR-Y�I'/t7�TMEAT �.YtA'N65 � ' <br /> � <br /> /��" �!�LC .!� � <br /> ��•' � i <br /> .�� <br /> PLUMBING MECHANICAL I <br /> . NO. TYPE OF FIXTURE OR IT[h1 NO. TYPE OF FI%TURE OR ITEYI � <br /> Toilet • NC-air handling units � <br /> Batltlub• Forcza air cyslems I <br /> Lavatory(Wash basin) • Gas pQing i <br /> Shower f�(� Walerheater � <br /> �g��r Kilchensink8disposal •,:''� � Gasfireplare ;-' <br /> "L�/e Dishwasher• � Gas 2nge � <br /> '�qfe Ciotlies washer• ,�'�� � �iothes dryer• ; <br /> Laundry iray i� � Ra��_hood • � <br /> _ Sink(servicelDBdmop/ele) � Exhaust fan• / ; <br /> _ �ackfiowp[EveMer Heatpump I <br /> _ Urinal : �� Unil hea • � � <br /> _ Drinkipg Fountain Boiler <br /> __ Floordrain Ref' e2tion � <br /> _ Grease trap dslave � <br /> ,Roo/drains � I fhcr ' <br /> � Othor =! ; <br /> I ' <br /> I <br /> -- � <br /> . qTYOFEVERETTLOCALSALESTARCO[lEIS310ti I <br /> 1 haiahy ceritify that I have read and axamu�ad this application and know the same lo be We and correcL All provisions of Imvs and t <br /> ordinaces govemiry this type of�vork will to complicd Ndth whether speafied herein or not.The granting of a penril does not presume <br /> to give aulhority lo vi�!ale or cancel tho provision of ony olher atoto or local low regulatin�corsWcfion ar the pedormance of <br /> constrv ' i.3h t I om outhonzed by ihe owner of this proporty to oerform the work Por which application is made and I compiy wllh the <br /> Sta� ontroctor Ln a 296.200 WAC. <br /> �---� l'�"� "O� <br /> Signa ure o onlractodAui orrzed Agenl ate � <br /> �i�M.�3�+�1 s .{-ist� � <br /> � <br />