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PERMIT APPLICATd�I� <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 320�J CEDAR STREET, EVERETT,\NA 98201 <br /> 425-257-8870—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FiiOM 8 AM 70 4 PSA �� — C� —O � <br /> SIIEADORESS �.� "•� /•���� �' r��1.,)� \ PARCELTAXI.D.# PERM I <br /> ,�L� i. -/� �\�:I��`,. "Vv-i ��vi C?C��13�11 � -L�:; Ui� �� <br /> LEGA LOT NO. BLOCK �CT <br /> DESC. <br /> O�� ADDFtE55 LfTY/LP . PHONE <br /> C'cl� L�� ��[7.('� LLC �`� �.��� �i�.l����'�.i �u•� `���� --1L �CC� '[ 1:;� �..i-1� '��V�ul <br /> 7ENANTNAME CONTACTFORVERMfT PHONE <br /> �: t�l�C1«;.' ll'��� ' <br /> � �� l � -' 1�.��,. ���.,� ���a>>'3����� `�C' -1�1 <br /> I � �1t i. <br /> COIlTMC70Rp �RE� ��TM� ��E <br /> l�1�\�l. Iv:��.�.. TV�<. � (�(i.C' `\2y'.ia , ,. �\.'-l"���Jv.�'� �-L�� ��vb(� ����C.� �1�(,'} >� <br /> CO[JTR.LICENSEA C�� .� , � ������ �� `i4 <br /> \ 1�C'��ti_\ l' �\�l( ;> <br /> USE OF BUILDING HEAT SOURCE CONTRACT PPoCE OF WORK <br /> �� <br /> I� � Y.`,��,�.vC\;`2-\ —Eloclric _Gas_Olher 1rL _��,(ii'U ' — <br /> WOFK OESCRIPTION <br /> 11��'.� 5�� ' Il \�� ,. � �\\.,•.���.�.7}c� l_�\?i�L '_����v� C-� ��c��i i k �n'i ��3`� ��� <br /> PLU6NBING MECHANICAL <br /> NO. 7YPE OF FlJI7Uf3E OR REM NO. 7YPE OF FIXTURE OR/TEM <br /> I _ Tale� — _ NC-air handling units <br /> ����� _ Forcedairsystems <br /> tavalory(wash basin) _ Gas pipirg <br /> Shower __ Waler haater <br /> Kilrnen sink 8 dis�wsal _ Gas Sreplace <br /> Dishv�sher �5�� <br /> Clothas washer Cbthes dryer <br /> Laundry Uay _. Ran98 hood <br /> Sink(sorvica/barlmoplelc.) _ Esheusl tan <br /> Backtlow provr.nler _ Heat ptanp <br /> Urinal Unit heater <br /> _ �riniting Fountair Boder <br /> FloorJain � Refrige2lion <br /> Grease lrap _ Woodstwe <br /> RooF dtains O��T <br /> Olher _ — <br /> ! <br /> CITY OF EVERE7T L.00AL SALES TAX CODE IS..t05 <br /> I herehy ceritify Ihal I have read and examineA Ihis application and know Ihe same to be true and cMecL AII provisions oF laws and <br /> ordnaces goveming Ihis lype of work will 6e complied wilh whelher spedfied herein or noL The granting of a pemut does nol presume <br /> lo pive aulhorily lo violale a�ncel the provision of any other stale or Iocai law regulating constrvction or Ihe pertortnanca of <br /> wnstruction.Thal I am aulhorized by the owner ot this prcpeAy lo pertortn the work(or which epplication is maie and I comply with 1he <br /> I Sl.:le Contradors Law 18.27 RCW and"19G.200'NAC. <br /> � <br /> � -�:-�� <br /> i �✓r��v✓. Ci '� '1� . <br /> ISignature of OwnerlContFaclorfAuthonzetl Agent Dale �/a <br /> �-----� _._ . . _...—_. <br />