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! <br /> PERMIT APPLICATION <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org l <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM �� ��� �v <br /> SITE ADDRE55 � %:� � PARCEL TAX I.D.# MIT# <br /> , � ._ �, �-�, ., SL—...L / �/J - �O <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION� <br /> DESC. <br /> OWNER � ADDRESS `�y CITY2IP PHONE <br /> s rt <br /> �; . ;��,� � , .� ���muL, lc�� z5- r9 �'' .�{,,,z S� t✓�%�'{� <br /> TENANT NAME CONTACT FOR PERMIT PHONE `C(t�, ,,3 Q S I �c� <br /> v�. _> I�c: h �r C-�-Pn�C���1 :�P1-�-� f'�cuJ EallAIL �r�ehrac�mcchnni[; �,C�-n <br /> I�tC��� ���el ��l�ni (�:� � 3i�C j��Ls3 /G�C" J�'C �e �'�., }�:, �+2��. 2z f.��7 � . <br /> CONTR.LICE SEi �� f-GS'f- <br /> N ��l � vtnrn �r �� � z � > <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> C� <br /> Electnc _Gas Other '� � Q��(� <br /> WORK DESCRIPTION <br /> ��E"�.�i�t�_ 1 �r;�C, .� ��� 1� ��t� ��<`��i�H���,,-,i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toiiet AIC–airhandlingunits <br /> Bathtub Forced air systems <br /> 2 Lava�ory(wash basin) Gas piping <br /> Shower Water healer <br /> � Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> � Clothes washer Clothes dryer <br /> � Weter heater _ Range hood <br /> .`;ink(service/bar/mop/etc.) Exhaust fan <br /> � Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkin�Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> �� Other��i��- <br /> �i a1 ,r <br /> CITY OF EVERETT LOClLL SALES 7A7(COUE IS�106 <br /> I hereby certify that I have read and ezamined this application and know the same to be true and corred. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorily to violate or wncel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the ovmer of this propeAy to peAorm the wvrk for which application is made and I comply with the <br /> Stale Contraclors Law 1827 RCW and 296200 WAC. <br /> , <br /> _r <br /> � , � �, ��� 1:� -; � � ll�/, �. <br /> Signature of OwnerlContractorlAuthonzed Agent Date <br />