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• i <br /> PERMIT APPLICATION <br /> CI7Y OF E1/ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www,everettwa.org <br /> i PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �OG�.—�L( <br /> SITE ADDRESS PARCEL A7(i.p.p PERMIT A <br /> o �a �u 50 � �-�� <br /> lEG LOT NO. 9LOCK TRACT OR 3UBDMSION p <br /> DESC. <br /> OWNER ADDRE33 GfTY(11P VMONE <br /> �VY 4, �.t 4DYl �a �Ta ��a . q-�1rna ! <br /> TENAMT NAME CONTACT FOF PERMIT PHONE aO�y .x�� `�rl�� <br /> I�(V1.i 'i (7 �Lh1.i1R.(1 EMA1�.�U YYI.i C�i:�D7 <br /> �T� R ��pf1 �Y�q AD RE99t{�pCj � y CITYfLIP = . <br /> -\ P� ��;�s a�ti aa8 a�+.� �:�� <br /> CONTR.UCENSE S ��y�1 � <br /> Br��� ��1 <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> ^��Q _Electric�Gas�other / � � � <br /> WORK�ESCRIPTION <br /> �t�.ac.� C�0. � .Cfvr �e �._ <br /> PLUMBINO � MECHANICAL <br /> NC. T'!pE OF FII(T1JRE OR IiEM � no. irPE oF nx�RE OR ITErd <br /> _ Toilet � AIC—air handling units <br /> Bothfub � Fo�ced elreystemg <br /> � Lavatory(wash basin) <br /> Gas piD�ng <br /> _ Shower � ' WoterhBater <br /> _ IGtchon sink&disposel ` Gns fireplaw <br /> _ Dishwasher ' Gas ranga <br /> _ CIDll7B5 W03h8f i � ao�hea dryer <br /> ^ Waterheator i RanQehOod <br /> � Sink(cerdct/bar/mop/eta) ExhauSt fan <br /> _ Backflowprevcnter ' Heetpump <br /> __ Unnal � � Unif heator <br /> _ Drinkinp Fountain Boilcr <br /> _ _ Floordrain � Refngeration <br /> ._ Grxasetrep � Wo�Ero� <br /> _ Raofdrei�s _ Other <br /> -- Other I — <br /> CfTY OF EVERETT LOCAL SALE9 iµJ(COOE IS 3105 <br /> I hereby certify thet I have read and examined thin oppliwtion and knrnv the some to be Uue and cortecf. !ul provisions of laws and <br /> ordinpnoes governing thls type af worlc v,411 be complied wltA whether speciflod hereln or nM. The grdntine�of n pertnit does not preeumo <br /> to give authority to violaln or cnncel the provision of Any other ntafa or ioral iaw mgulepng conutrvetion or tne pertortn�nce ot <br /> coA ctlnn.TTia1 i am aufho ' by the awner of mis pmporty tn parie�m the work for which applicaUon Is matle antl i camply with the <br /> Sfate onVactor�Law 1E},7.7 anA 2 .20Q WAC. <br /> / ^ � <br /> S aNre ot wnerfConira rlA onud Ag�nt D �, <br />