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_ �u � �, �.i�„ �k�rv ni v�:..�-� I <br /> PERMIT :�PPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810— FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROIN 8 AM TO 4 PM <br /> SITE ADD ESS � � PARCEL TAX I.D.X RMyy� <br /> O �-(� �f✓e GJ �'�3 �1-C6 I OC� � d C��,� U, � <br /> LEGA l0T NO. BLOCK � THACT OR SUBDMSION N 1 �, . <br /> DESC. '- �1A7 � A � �`f�C'�'�lO 1 Y\'�t"GVG� <br /> OWNEH �� '�j,}�( 1�jC � 'f1�GZYys Q � G ` 3'[� C�ry21P FMONE <br /> .�—n„cvc`-hv-�. in�S-1�m�n}s 1,-YJ 3k���-�f5�-� -5�3� <br /> TENANT N1WIE CONTACT FOR P RMR FXONE3(�U�J I Ft I <br /> � <br /> I ' eAn�,�esenc�'�z- E-�N�'�''�� i-H�'r�,`�w, <br /> -�a�1� C_��-4r J C�%nS-Fru.. � c�l.3r�c� • <br /> CONTR. ICENSE# 1 � I IQ,/7 ! bd' L� <br /> c � 1.��.1�1�� �. �C?�CC 13Gi-�- 1)�YI�ISI, i , <br /> USE C) UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S � � _Eiectric �Gas_Olher <br /> WORK DCSCRIPTION <br /> S�� N�v: Cv-,-�S�t�'�-�.-�:�`r c� 1 I�gS � L 3 i `� <br /> ���c�r' ��•.c� I �C� - b � ' �(U l�_- � <br /> PLUM IP1G MECHANICAL <br /> NO. TYPE OF FlXTUqE OR REM NO. TYPE OF flX7URE OH ITEM <br /> Toilet A/C—air handling units <br /> Bathtub 1 Forcedairsystems <br /> � Lavatory (wash basin) � Gas piping <br /> �' Shower � Water heater <br /> 1 Kitchen sink&disposai � Gas fireplace <br /> � Dishwasher Gas range <br /> i Clothes washer i Clothes dryer <br /> � Water he2ter i Range hood <br /> Sink(service/bar/mop/eic.) � Exhaust fan <br /> BackFlow preventer Neat pump <br /> Urinal Un5 heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigera�ion <br /> _ Grease trap _I Woodstove <br /> = Roof dreins �I Other = <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 ` <br /> I hereby ceritify that I have read and examined ihis application and know;he same to be true and correct. All provisions of laws and <br /> ordineces 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 aulhority to violate or cancel ihe provision ol any other state or laal law regulating construction or the performance ot <br /> consiruction. That I am authorized by the owner of this property to perforr�he work lor which appl�cation is made and I comply with the <br /> State Contracrors LaN•18.27 RCW and 2.96200 WAC. <br /> Signature of OwnedConhactodAu�horized Agent Date <br /> `/� <br />