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i � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 42�r257-9857-�www.evereriwa.org <br /> APPLJCATIONS ARE ACCEPTED FROlA 8 AM TO 4 PM y -� -1'3 <br /> SITE ADDRESS PARCE TAX I.U.�k PERMI7 A <br /> � ��.� � 3�c,���( <br /> LEGA LOTNO. BLOCK TRACTORSUBqVI3lONM <br /> DESC. <br /> OWNFR AOORE99 � CITYlLP VMON'c <br /> Qr'i�.r� �u�1���n� �(� o�-.. �l� ��� - I a A �3 <br /> TENANTNAME CONTACTFORPE(R�N��i PNONE�D� �aYj �SI'jt�O <br /> I�(11.i L <� '1.511/f1A�4-n E#IAll�t IY1.11:��.`bC <br /> X7PAC70R �,yV..P� � ' 1'� ADDRE Cj �LCI�A, t1� M NE — `�m <br /> •4�'� aClc od a�` �q 0 <br /> CON7R.LIGEN3E�! (� \_ _ (��,�(1 ��,�� <br /> CJC�f..1U'1 Y�r�:��l �'� <br /> USE OF BUILDING ^ HEAi SOURCE CON�RACT PRICE OF WORK <br /> S�\/ I �Eledric „Gas_Other ��" <br /> 1`--- <br /> WORK ESCRIPTION � 1 � <br /> 1�s��1\ �C.��-c � � �o��- w '� <br /> PLUMBING MECNANICAL <br /> NO. lYPE OF FIxTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tclle[ _ A/C—airhandlingunits <br /> Uathtub _ Forcad air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower _ woter�eeter <br /> ! Kltchen sink&disposal _ Gas fireplace <br /> � Dishwasher Ges rsnge <br /> Clolhes wesher � Cblhes dryer <br /> � Waterheater Rangehood <br /> _ Sink(servicalbedmop/etc.) Exhausttan <br /> Backflow prevem¢r = Heat Dump <br /> Urinal Unit heater <br /> Drinking Fcuntein Boiler <br /> Floor drein Rehigaralion <br /> Graase lrap WaaJstov�e <br /> Raof drains � OthC� <br /> — Othc� —I <br /> CITY OF EVERETT IOCAL SALES SA%CODE IS J106 <br /> I hemby certiry that I have read and axamined this appliceHon and know 1he same to ba hua and corcect. All provisions o�laws and <br /> ortlinances goveming this type ot work will be compiied with whether spedfietl herein or not.The granting of a pertnit does not presume <br /> to yive authorlty�o violate or cancel Me provision ot any other 5tat¢or locai law regulaUng eonslrvction or the per(ormance af <br /> con,l c;ion.That I am authori d by the ownar oi Ihis property to pertorm the vrotk for which applicatlon Is matle snd I comply with the <br /> S(ala ,onlractors Law 18.27 and .200 WAC. <br /> � , � � aa �� <br /> o pture oi wner7GonVect r! u onzed Agent D te <br />