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— � � "� I <br /> � <br /> � r�RIMI� APPLICATION <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, 1h'A 98201 <br /> 425-257-8£i10— FAX 425-257-8857—www.everothva.org <br /> APPLICATIONS ARE ACCEPTED FROAA 8 AN TO 4 PAA l �� �C <br /> I U� ,��� ��� <br /> SITE ADDRESS PMCEL TAX I.D.X PER R/ A� <br /> �Lll � C � _ ` ' 'O�v �� 0( <br /> IEGA ' L07 NO. p�K 7pACT�q y�Bp�y�p►�� <br /> DESC. � — � ��7_ v� <br /> � <br /> �� C- ,��x �' _,� ry5v I (N�' E� Oa'Z <br /> r,����i a�-hvf � �nvf`�=t-r�� n-IS �r, � ��i � -�- <br /> TENANT NAME I CO!lTACT FOR pERM1T PHONE��L-f � S I� I <br /> � n n �� �d_� E��m� , �n5e�n <br /> �t.91e. �'� C�nS-1�'uC�l lNl, 1 n v ' <br /> cowrr�.��cFxae r - <br /> ����c�.-�aN�� �c ��xix �30�- mar�5U ��1rL �,-�� �t�aZC� <br /> USE BUILDING I HEAT 30URCE I COHTRACT PpICE OF WOpK <br /> �� _Eiectricx Gas Other <br /> WORK DESCRIPTION <br /> ,ti`,-e;�`� C;rn-,�t�r'►,�.C_-i-ib���� �- 5��--- l� lc_ 3 � c <br /> ���Ac;c' �, �� C�,�l'6' l : — G�<. " �� I �=;� "�l <br /> PLUMBING � M CHANICAL <br /> N�� TYPE OF Fl:CTURE OR REM NO. TYPE OF Fl7(Tt1pE OR ITEM <br /> Toilet <br /> � Bathtub aC–air handling units � <br /> Lavatory(wash basin) T� Forced air systems <br /> � �WP��B <br /> Shower 1_ Water heater <br /> � Ki�chen sink 8 disposal i Gas Tireplace <br /> T Dishwashe; _ ��n� <br /> � Clothes washer 1 Clothes dryer <br /> � Water heater =L Ra�e�� <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ BacMlow preventer Heat pump <br /> _ Urinal � Unit heater <br /> _ Drinking Fountain _ f3piler <br /> _ Floor drain _ flefiperalion <br /> _ Grease trap _ Woodstove <br /> _ Roof drains _ p�her <br /> Other <br /> CITY OF EVERETT LOCAL gALES TN(CppE IS 3/05 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and ccrtect. All provisions of laws and <br /> ordinaces goveming Ihis type of�vork will be complied with whether specified herein or not.The gran�ing of a per.nit does no�presume <br /> to give authoriTy to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> conslruction.That 1 am authorized by the owner oi this property to pertorm the work for which appiication is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> Signa�ure of Owner/Contractor/Authorized Agent Date <br /> �lL <br />