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P�RMIT APPLICATI�nI 3 `�q.� <br /> C1TY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G�15p <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �j���G <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.O.tl PE fAIT M � <br /> 3o UD43�-0`��3� I�-D 1 l�� - <br /> DESC.f LOT fJO� B�LO"C TRA�OFiSUBD�a�N M <br /> R �� /i kJ P <br /> OWNEF ADDRESS CITY/ZIP PHONE " 6 <br /> -f'VIU'���l,t. C���"� lglo 12�-��Q�IIr r �v�ic� W� �9�Zo� <br /> TENANT NAME /�CONTACT FOR PERMIT PHONE �S�3� SaQ� <br /> I k/(M `�l �1� -t 1 /�.m <br /> � E-MAIL �Q L �l/" <br /> �� R . I <br /> CONTR.LICENSE N � (/a�'1.�� <br /> USE OF BUILDING HEAT SOURC� I COpNTRACT PRICE OF WORK <br /> I l�m� ,_Eleciric ,�Gas_Other D � �'J <br /> jT0 S IiJG�-(- �5ti+t�Y 12E5ics,y ' <br /> WORK DESCRIPTION � / / //.�y� �r1,-I� � _ :1��•� <br /> �C�v�.(/t c.vw,C «rCG/ 1}.D • <br /> �'YI��' ��'- D�Co <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> L Toilet — <br /> A/C-airhandlingunits �• �S�•^� � <br /> I Balhtub Forced air systems ' ' <br /> - 'Z Lavatory (wash basin) � Gas piping , <br /> � Shower Water heater �cx�� I,.T <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> I Disliwasher � � Gas range � <br /> Clolheswasher �f'SF'ny Clothesdryer G^ 's�'� <br /> = Range hood c I_� <br /> _ Waler heater � Exhaust fan CXI S� <br /> _ Sink(service/barlinop/elc.)�, ,S f;�� Heal um <br /> 8ackflow preventer — P P <br /> Urinal _ Unit heater <br /> Drinking Fountain � _ Boiler <br /> Floor drain �'1 _ Retrigeration <br /> Grease lrap �' _ Woodslove <br /> Roof drains _ Olher <br /> Olher — — <br /> CITY OF EVERETT LOCAL SALES TAX CQDE IS 9105 <br /> 1 hereby certify lhat I have read and examined this applicalion and know the same lo be Irue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whe�her specified herein or not. The granling ot a permit does nol presume <br /> lo give authority lo violate or cancel the provision of any other stale or local law regulating construction or the performance oi <br /> conslyr c4ior al I am horized by the owner of(his property to periorm the work tor which application is made and I comply with ihe <br /> Stat�Gontractor Law 7 and 296.200 WAC <br /> l / <br /> � �� � � <br /> Signature of w�edContractodAuthorized Agent Date �/ <br /> L� - -- � <br />