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{ <br /> �� . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT,WA 98201 <br /> 425257-8810—FAX 425257-f3857—www.everettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM y—'���v <br /> SITE ADDRESS PARCEL TAX l.D.t RMIT It <br /> '5531 Wi O5 f,0�(ioeooq- 4 0o S (� ��p3 - D3 Z� <br /> LEGA LOOT� BLOCK TRACT OR SUBDMSJQN f � <br /> DESC. 5� S <br /> v <br /> OWNER AADRE55 CITY/ZI �PHONE� A' ,,u r/y�1 <br /> �JIX �IC?!�" �C�' 1J�C. h Cl O l/�l �t.�,�nN V�T ! <br /> �A Mr <br /> TENANT NAME I , CONTACT FOR RMIT PHONE ' <br /> M� � q s Q- <br /> �fdLl(�'1Q e�u� � <br /> �oN„��bp�' d°"� ?�� � �dyb �i� 7sT � <br /> W�fi Wo�i�llh�,WA 4 7L <br /> USE OF BUILDING I — HEAT SOURCE I CONTP.ACT PRICE OF WORK <br /> I <br /> w�QJ�j Eledric Gas 10ther I�� • <br /> WORK DESCRIPTION <br /> :��o��� Tb t-�''4���� IN av���n���� . �,aK a;�'-�c,f� � <br /> ��'I�k-�-r� I��u�<<*� w� c�, ��'�,�,�o,y , 37Vv <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR I7EM NO. IYPE OF FO(TURE OR ITEM <br /> Toilet A!C—air handling units <br /> _ Bathtub Forced air systems <br /> lavatory!wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas firepta� <br /> Dishwacher Gasrange <br /> _ Clothes washer C�othes dryer <br /> _ Water healer Range hood <br /> Sink(service(bar/mop/etc.) Exhaust fan <br /> �ackflow preventer Heat pump <br /> Unnal Unit heater <br /> Drinking Founlain 6oiler <br /> _ Floor dram Refrigeration <br /> Grease trap Woodstove <br /> Rnof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CUDE IS J105 <br /> I hereby certify thal I have read and examined this application and know the same ro be true and corted. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whelher specfied herein or noL The granting of a pertnit Aces not presome <br /> to glve aulhonty to violate or cancel the provision of any other state or iocal law regu�a6ng construction or the pertormance of <br /> construdion. That 1 am authorized the owner of this property to pedorm lhe work for which applica6on is made and 1 comply with the <br /> State C ors 27 ., a d 29G200 WAC. � <br /> Sig ature C ir dAuthonze gent Date D <br /> ��,� <br />