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� <br /> -� <br /> ; P�RMIT APPLiCATI�N <br /> � CITY OF EVERETT PERMlT SERVICES <br /> ! 3200 CEDAF. STREET, EVERETT, WA 98201 � <br /> 425-257•8810— FAX 425-257-5857 — wv✓w.everettwa.org i <br /> I r I� <br /> i APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DF.BIT & CREDIT CARDS ARE NOT ACCEPTED <br /> I SITE ADDRESS PARCEL TNC I.D. # QERMIT# <br /> !, s� � �� '� s�r, o���N�ra�� _ G -�p <br /> 'i LEGAL LOTNO. BLOCK TRACT <br /> o=_sc. ,3 s� <br /> OWNER ADURE55 CITY/ZIP PHONE 3 Co _� �� _y��i ,y <br /> ;�S � D P/�R�" C/PEE/r �� C �,��j/G C L/�dfN l�A ' Y���� <br /> ' TENANT NAME . CONTACT FOR PERMIT . , PHONE ' � <br /> � ... . I ;'�./� /o.�?��� �z,t .5`.Z2 - � �, i•� �I <br /> CONTRACTO, r/� � � _ �/ ' <br /> j i N�i r' ADDRESS CITY2IP Py,ONE ' <br /> i �ii�/f' `�_ ' . . � tio-9�;�r- S�doy II <br /> I CONTR. LICEN E# f�� rJp � G�v � � , � ` , I <br /> P��e ,�c.�� o�.z« � �� , C.Cii✓�`o�� 4/.f Y�'z�: <br /> I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> I ���u� E ���" � I _ Electric �. Gas__Other /� y O �O I <br /> i <br /> I WORK DESCRIPTION ' <br /> I C p ��/ S f/Ck C/ /ON O � N�rnJ S�N�< _F �H�vii /�/ � W E//i i�/c� i <br /> / <br /> C � <br /> PLUMBING MECHANICAL ! <br /> ; h0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> , 3 Toilet A/C—air handling units — ! <br /> <- Bathtub Forced air systems <br /> � Lavatory (wash basin) � Gas pipir.3 <br /> I � Shower Waterheater I� <br /> � / Kitchen sinl;& disposai Gas fireplace � <br /> 7 Dishwasher Gas rahge � <br /> � Clothes washer � Clolhes dryer ! <br /> I .L Laundry tray .�. Range hood � <br /> , _ Sink(service/bar/mop/etc.) - �� Exhaust fan <br /> BackFlow preven;er � Heat pump I <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration , � <br /> Grease trap Woodstove <br /> _ Roof dreins Other <br /> Other — I <br /> -- — — i <br /> CITY OF EVERET7 LOCAL SALES 7AX COOE IS 3105 � <br /> I hereby ceritify that I have read and examined this application and know the same lo be;rue and correct. All provisions of laws and <br /> ordinaces governmg this rype of work will bP complied with whether specified herein or nol. The granting of a pe�mit does not presume <br /> . ro give authority to violate or cancel the provision of any other stale or local law regulatin� construction or the per(ormance of <br /> constructicn. That I am authorized by the owner of this property to perform the work for which appiication is made anJ I comply with the <br /> State Con rors _aw���,8'2/7 RC�W a 29 .200 WAC. <br /> �`�U�2 J/ / �—,Z�—O � �'� <br /> S�gnaiure of Owner/Contr torTAuthonzed Agen Date t/ <br /> IL I <br />