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. � (- t' <br /> PERMIT APP�ICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www•everettwa.org � �.30"0� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(ti) 'J OL6 � �� <br /> SITE ADDRESS ;�L�C'�R�"��'t�'%'�3�Z 90y43��� PERMR N <br /> /5� s�9'�sf�t1.�� �. ��6 - (�� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIV�ILS�ON JI �yf <br /> DESC. CIEYIWZ'�CLI/ , .. � G�O�"w� <br /> OWNER ADDHESS CITY2IP PHONE <br /> C�6�K✓F5�'7rz�.,`l3 A1��l�i�y�sf�1c �Zy '��' <br /> TENANT NAME CONTACT FOR PERMIT PHONE �j"r�l�f j/ !�/�j� <br /> I DANO✓�/Y%�G�,'� E•MAIL��G��I'7E�3� � � <br /> cs�E��!!�� izi�zsf�' A�:z�;Sye.I��i�/O%s�r u��o�/¢�zx� rccsr�s�'s"/ <br /> CONTH.LICENSEl1 ��f��;li•���Lt�� <br /> /1�- 7 <br /> USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � � r � �j ��� <br /> f��/� �Q���f��'jCf'F��� _Electric �Gas_Other � <br /> WORK DESCRIPTION �7/S,�f <br /> ��% <br /> /Q�E�w �O��JI7�[ll`7/N/f <br /> �t��� i4`l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> �_ Bathtub � Forced air systems <br /> � Lavatory(wash basin) .fS Gas piping <br /> �y Shower � Water heater <br /> / Kitchen sink 8 disposal 2 Gas fireplace <br /> � Dishwasher = Gas range <br /> � Clothes washer � Clothes dryer <br /> � Water heater � Range hood <br /> � Sink(service/bar/mople�c.) _� Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain � Retrigeration <br /> Grease trap _ Woodstove <br /> Rool drains __ Other <br /> Other _ -- <br /> CITY OF EVERETT LOCAL S0.LES TA7(CODE IS 3105 <br /> I hereby ceritify that I have read and examined�his applica�ion and know the same to be true and correct. AII provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give ority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> cons ct' n.That I am a o ' e by the ownerai t ' property to perlorm the work tor which application is made and I comply wilh the <br /> Sta C tractors Law .2 and 29620D C. <br /> l> �/07 <br /> S ature o O ne tracto utflonzed ge t �ate 1/ <br /> �;� GsGEs e �tE',S z <br />