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( c <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETf,WA 98201 <br /> 425-257-8810—FAX 425-257-6857—www.everettwa.org <br /> APPLICAT10N5 ARE ACCEPiED FROM a AM TO 4 PM ��_ L�..jJ � <br /> SITE ADDRESS PARCEL TAX I.D.• P ���p� <br /> I 3 t\ �.:� F� ��.�'�.� C U`-t 3 b c � ,p "�{if7 <br /> LE LOTNO. BLOCK 7RACT <br /> DESC. <br /> pyyNpt ADDRESS CfTYlDP � PHOfE <br /> l:.`zP Gb (-Idr�l �.�. 0 �.9;a.�\ l�velr.ti� A.r. Sv�tt �w fv4�iH `l��� i:� <br /> TENANT NA11E CONTACT FOR VERAIIT VIIOIE <br /> 3�� �s�.�70 <br /> �1`cG��YC•\ CS Y�2�. Lz.v 1 1 �12.:������� -�1-44 <br /> CONTRACTOR ADORESS CRY/LP %10lE <br /> �1�D��c` �v�i v� , Sv�c„ `��Gc [, i"+ 2u'kic.,,r �\�tE, �'�\.,�,� I�iO �lY�,�7S <br /> coNrn.ucasew <br /> '� j�c�.�n;t t•����r.p ( ��a-�) j `I�� -Sr.Hy <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> L�•�4„•ti, � ,� c ,2-\ eiecmc cag aner � 3-,L�pe"= <br /> WORK DESCRIPTON <br /> S �v� :.1\ l� � 1u�:� �\Ivw�i ✓�z�ticti ��r,��„ L�.. `.�oY�-�v-i:.11� �c-'Sc_lc'1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF FlXTME OR I7EM <br /> Talet I11C-air hendling units <br /> Bathlub Forced air syslems <br /> lavatory(wash basin) Gas pipirg <br /> Shower Water heater <br /> IGtdian sink 8 dispasal Gas fireplace <br /> Dishwasher Gas range <br /> C�olhes washer f�otlies dryer <br /> Laundry IraY Range haod <br /> Sink(serviceThadrtaplata) Exheust fan <br /> Badcflow pravanler Heat pump <br /> Urinal Unit heater <br /> Drinlang Fountain Boiler <br /> Floor drain Refigeratlon <br /> Grease trap Woodstwe <br /> Roof dreins Other <br /> -- Olher <br /> cm oF�nen wc�u.sa.es r�x cooe is a�os <br /> I hereby cerility lhal I have read and ezamined this appFcalion and krww the eeme Oo be true and eorted. PJI prtrvisions of laws and <br /> ordinaces goveming this lype d work will be complied with whether spadfied herein or rat The granting of a perr�tit does not presume <br /> lo give aulhmily to violale or cancal lhe provisim of any other sfale a loral law reguladng oonstruction a Ihe perfamance of <br /> cons Wction.That I am aultwrized by the owner of Nis property b perform the work fa wlrch applicadon is rtiade and I canply with Ihe <br /> State Conlradors Law 18.27 RCW and 296.200 WAC. <br /> ..���..v\ ��':,_ ��, �( -�J'C`� <br /> Signature ot Owner! lalAu�honzetl Agent Date <br /> ��2 <br />