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� ( <br /> � PERMIT APPLICATION <br /> CITY OF �VERETT PERMIT SERVICES <br /> 3200 CEDAR STREEf, EVERETT,WA 98201 ` _I �—�b <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM M� �) _�� <br /> a <br /> SITEADDRESS �O/ n3f� � I i• �� n�yO��2��� PERMITN <br /> S pL �/� Of. <br /> LtGA LOT N0. BLOCK TRACT OR SUBDIVISION X � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> jr��; i,�� '(orpo,� �f 3C 4932 ,vE 9�'—`� Sr S�-[Ne 9 �//S <br /> TENANT NAME � CONTACT FOR PERMR PHONE apL_�(J-I�l(y pK f 1 <br /> �w .�cti�om�e�Q. $1cQy. I�Ess D�s e-Ma� M.�C�e��kr�� <br /> �VCr'�rcen. ��r�er..�o;.. �.�-� S. �o.._ St S�+.cE�G 96log so�-�3-/,�YY <br /> CONTR.LICENSE N E V F 2GQ�95'f fL 2 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric �Gas_Other ��Q(�. <br /> � <br /> WORK DESCRIPTION <br /> Jnskll.;.F,e,� o-F one. �,5 �� (27tA� a-wo Ce��"� �.•�s, ant w."-�'he�-%, ,,Qua�w� r �c »wc� <br /> �,� cQeJlc�S– _ . . ' _ . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet 1 AIC-airhandlingunits <br /> Bathtub � Forced air systems <br /> Lavatory(wash basin) a,i�� Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplac�3 <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heatsr Range hood <br /> Sink(service/bar/mopletc.) 4� Exhaust fan <br /> _ Backfiow preventer Heat pump <br /> Urinal � �< Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap _ Woodstove � <br /> Roof drains _ Other_ _ <br /> Other - <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify ihat I have read and examined this application and know the same to be true and correct. All provisions o/Iaws and <br /> ordinances yoverning this type ot work will be complied wilh whether specified horein or not.The granting of a pennit does not presume <br /> to give authority to violate or cancei lhe provision of any other state or Iocai law regulating construction or lhe�anl;mance of <br /> construction.That I am authorized by the owner o(lhis property to perform the work tor which applicatlon is made and I comply wilh lhe <br /> State Contract rs Law 18.27 RCW and 296.200 WAC. <br /> ���i��"�--'�"'w�— S�1�O <br /> Sl�g aWre of OwnedContractodAuthorized Agent Date <br />