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PERII�IT APPLICATIrON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED fROM 8 AM TO 4 PM <br /> _SITE ADDRES��L� �� � 'r 2 PA�7 DD �x�I� � O(J I/ ,I RMWtC)—C�QU <br /> 1 ,L � G l� <br /> LEGA LOT NO.� BLOCK TRACT OR SUBDIVISION� <br /> oesc � N ,�' P�fJT C�o��" -�G2D,2��s-D� <br /> OWNER ADDRES dTYIZIP PHONE ���^'\ <br /> �7J.J <br /> �AE� c E Cf>u,ur,�� CoNsr. Po �x �30�- MRrzys�i�le W,4 -�5�3� <br /> lENANTNAME CONTACTFORPERMIT PMONE��C_,.¢�',¢,_���^7 <br /> �,TFSS�C�I �ivDEF�JD�� E�� �:�chovneS �n�� m <br /> �a�<E C'ocrNr,�'y co,u.�r���T%o,v PO PX 1309 �'l�Y�vr� 3�0�s�-s� 7 I <br /> CONTR.l10ENSEt �CL�/_�/�J��.ZN� <br /> USE OF BUILDiNG HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> f 1/Ew �s�� _Eledric xGas_Other <br /> WORK DESCRIPTION <br /> n��w� �F-� — gl�S►� � 335 �� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> d� Toilet A/C-air handling units <br /> � Bathtub % Forced air systems <br /> �� Lavatory(wash basin) a� Gas piping <br /> � Shower � Water heater <br /> � Kitchen slnk 8 disposal � Gas fireplece <br /> � Dishwasher Gas range <br /> � Clothes washer Clothes dryer <br /> � Water heater � Range�ood <br /> _ Sink(service/bar/mop/etc) E�chausl fan <br /> Backflow preventer ,� Heet pump <br /> Unnal Unil heater <br /> Drinking Fountain Bciler <br /> Floor dr3in Refngeration <br /> Grease trap Wc?dstove <br /> Roof drains Othec <br /> Other <br /> GT'OF EVERETT LOCAL SALES 7AJ(CODE IS 3105 <br /> I hereby ceRi(y that I have read and ezamined this appliqtion and know the same to be true and mrred. All provisions of laws and <br /> ordin2nces govemmg this type of wnrk will be comphed with whether spe�fied herein or nal. The granting of a permit does not presume <br /> to give authonry ro violate or�an I the provision of any other state or local law regula6ng construdion or Me perlortnance of <br /> construction That I am auNon by the owner of this property to pertorm the work for whicF:appliqtlon is matle and I comply with the <br /> ate dors I 3w 18.27 and 96200 WAC. <br /> �f,�� //�—lr ��� 2-D/� <br /> i ture o�Owner/Contr ctor/Authon Agent Date �Z <br />