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o � <br /> ' � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everettwa.org <br /> � <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � _'a.� —�� <br /> SITE ADORESS PARCEL TAX I.D.N PEHMR M <br /> 23D � 00934194000ioo s_ <br /> IEGA l0T NO. BLOCK TiIACT OR SUBDIVISION� <br /> DESC. <br /> � OWNER ADDRESS CEN/�P PMONE <br /> ��,��, ��v�, �vu <br /> iENANTNAME COHTACTFORPEAYfT PHONE9� 765- 09qq <br /> _`�� /(�W�6 t�Q I/�t�Nde� � e+�a� M fUcfy C�C'o�n�aSL. <br /> CONTRACT A I <br /> C01fiA.UCENSE 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �..�(.W� V t���� �" I _Electrw _Gas__Other � 2���d <br /> WORKDESCRIViION �ppl�� 3 a�fe�►,as (..�i'�i 3 J�¢,,�� 2tnqch�d$ � a��P 1 Ov�ru�(�Faq.e. <br /> Pro'lecl�r, un.��ePia�i{ �o -�.o d�,7¢•�na5 d� � a���.c Gab,�tf'� 2 Fx�D� 3 F'RIG, 12 <br /> Gl,�pinxars� 3 7r:.as � 1 Lhu Cr.E,4 8��� �. fu{6vicQ czb(¢, lJe anLl ��o�•c (o a►n�7�"aJ <br /> n?.v 6(pc. _ <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FlI(TURE OH ITEM NO. TYPE OF Fll(R1RE OR IfEY <br /> Toilet A/C-air handling units <br /> BatMub Porced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showe: Water healer . <br /> Kitchen sink 8 disposal Gas lireplace i <br /> Dishwasher Gas range I <br /> __ Clothes washcr Clothes dryer <br /> Water healer Rangc hood <br /> Sink(scrvicNbar/mop/elc.) Ldiausl lan <br /> __ 6adcllow preventer Heat pump <br />� Unnal Unit heater <br /> Dnnking Fountain _ Dailer <br /> Floor dram RelrigeraUOn <br /> _ Grcase trap Woodstove , <br /> _ Rool Jrains _✓ ai�:�_ _A�,�r,,,as���tL.�P�w...� <br /> on,��- — -- <br /> GTY OF EVERETT LOCAL SALES TAX COOE IS�10.5 <br /> I hereby ceritity that I have read and eaamined this application anA know Ihe same to be true and corred. All provisions ol laws and <br /> ortl�nac�goveming this type of woAc wfll be complied with whemer specified he�ein or noL The graoting ol a permil does not pesume <br /> lo give aNhoriry to vidale or�nccl tFa provisim of any other state ar b�al law regulating mnsinution a tfie peAortnance of <br /> consiru �on. at I am authorizecl by Me owner of this property ro peAortn the woAc for which application is made and 1 comply with tfie <br /> State ntra rs w 18. W and 296.200 WAC. <br /> 0 -�- <br /> Signature ol Owner/Contra r/ uthonzed Agent Date <br /> �/Z <br />