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.. Jan. 22. 2014 1Q: 04A�d h'o. i �74 P. 2/3 <br /> PERMIT APPLIGAT'ION <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9E1201 <br /> 425-257-8810– FAX 425-257-8857–www.evereltwa.ory - <br /> APPLICATION:i ARE ACCEPTED FROM 8 Ah1 TO 4 PM <br /> / -- 22 —►� <br /> SiTE ADDRESS i � PARCEL TAX I.D,ft PERP�1lT 71 - <br /> � � �_I�1 _ <br /> LEGA LO7N0. OLOC 7qACTOF3UBDIVI510Na <br /> DE50. <br /> OWNEFI ADDRESS CITY(lip PHONE <br /> �1 rna o�_c� SaM� as above �fZ� 25$ g17�' <br /> TENANT NAIdE I CONTACT FOR PERMIT PHONE���J �`� ���!� I <br /> Ti 1 �'"' __� E•IAAI 1e�11��E� Q'C����I'�4��� l'�I I <br /> C(�'1M�ti1►ic{ It1�- �T�� � �t.l. ��re/l q�w� G- /t --T <br /> coNrA,uc��,,e I �tZJ��i"1(GG��o1C' , <br /> ��� b9�R�+ <br /> US[ OF DUIL�ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ _Eleclric V Gas_Othor 25�5 r <br /> WnaK DpSCRIPTiON <br /> _ '�k,p IA,C�. q S �v r�a.cQ, �1- -�- s�.-� � <br /> 4—�LUMBING 4 MECMANICAL <br /> NO. TypE OF FIXTURE OR ITEM NO. TYPL OF FIXTURE OR ITGh1 <br /> _ 7oilet q/C—atr hantlling units ^ <br /> _ �aUilub � Forcadaveys�ems <br /> � Lavalory(wash basln) _ G3S piping <br /> � Showor NJater hrater <br /> ' _ KIlr.hcn sink&disposal Gas firoplace <br /> __ Dishwashor Gas ra�pc <br /> _ Clo�hes wnshor Clothoc dryer <br /> __ Waler heater � Nonpe hood � <br /> __ Slnk(serv(culGar/mop/etc.) [zhausl fan <br /> _ Backllow prevenler Heal pump <br /> �__ Urinal Unll hoalor <br /> . __ U�inkinp Fountaln poller <br /> . Hoordriin Rel�ipe�alion <br /> ____ Groasritrap � Woodslove � <br /> Hool tlrains — – � Olher���}Jr J�a_�� <br /> � Olhcr__ <br /> CITY OF F.VFIiCTT LUCAL 3ALE°i TAX CODE 19 3105 <br /> I he�eby cori6fy Ihal I hpve read and oxammed Ihls appliCalion antl knovi Ihe sorny to De hue and corr:�cl. A�I provisions ol lav�;;�nd <br /> . ordinaces povernlnp Ihl9 rypo ol work will be complied wllh wholtior specllied hr.rein or no;. The�ranling ol a permit does noi presamE� <br /> lo pive authonty lo vipla�e or cancel iha provicion of any Olher stato cr local iaw repulabnp conctructlon or Ihe peiforrnuncn of <br /> construclion.That I am aulhOrized by the ownCr 01 Ihls properly lo pertorm Iha work for vmlCh applicahon I5 maUe and I comply wtlh ihr <br /> Stale Conir3ctors Law 18.27 RCW and 196,p0U WAC. <br /> c 1 � 22,I,�' <br /> Sipnaw ol wnedCo�nc�oqauVi i Agen� Dato <br /> . � <br /> ------ — ---------- -- --------- —J <br />