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n���. 2'�,. 2^ 12 7: �oA,� ';s. �94ri � � � <br /> _ _ �� <br /> PERMIT APPL.ICATION � <br /> CITY OF EVERETT PERMIT ��RVICES I <br /> 3200 CEDAR STREE7, EVCRETT, WA 98201 � <br /> 425-257-8810— FAX 425-257-8857 —www.everetiwaArg i <br /> APPLICATIONS ARE ACCEP7ED FRQM 8 AM TO 4 PM �3 `-o�( -1 Z � <br /> SITE ApURESS PARCEL TAX I,D.N PERMIT# . <br /> �315 "l�"' ST Uv��t 33�2. zo$-o ; <br /> LEGAL Lo7 No. BLOCK TRpCT Op 9vU01VI510N p I I <br /> OESC. <br /> OWNER AD�RE95 CITV2IP PHONE � �r� <br /> K�� �Sunn�� Poello� ��n� E�, q8zol �25 252 I�iB ' ':' <br /> TENANiNAldE CONTACiFORPERMIT PHONE I � <br /> N2�a 2aq �a�C��a „� <br /> I �?�O�I'� e.�ewL �, <br /> �� +ae_a`�ih� Ih c.. ���5 �,3ro0.��vu,�.� £� q8aol y252�lola <br /> �o�,�'Cm����Oq5R4 � <br /> , <br /> USE OF BUILOING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � <br /> clecvic _Gas ott�er S�� �o <br /> WORK DESCRIPTION <br /> Ins�c� ll �C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE CF FIXTURE OR ITE1,1 <br /> Toilet � A/C _ <br /> ealhiub ced alr sys�ems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Water heater <br /> —' Kilchon sink&disposal � Gas�ireplece <br /> Dishwashar � Gas ranpe <br /> Ciothes washer Clolhys dryer <br /> Waler heator � Range hood <br /> Sink(servica/badmop/etc.) Exhaost fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain � Boilor <br /> Floor drain Rp(rigeralion <br /> urease trap Woodstova <br /> Rool drains Other <br /> Olher <br /> CITY OF EVEflETT LOCAL SALES 7AX CODH IS 3f05 <br /> I hereby ceritify that I have read and oxamined Ihis appllCation and know�he sanie lo be true and correcL Ail provisions o�laws and <br /> ordinaces govem�ng Ihis type of work will be complied wilh whather specified herein or noL The qrantlng of a permit does not presume <br /> to pive aulhority�o violate or cancel ihe provision ol any other stato or iocal law regulaling con,truclion ar the pedormance oi <br /> conslruction.That 1 am authorized by Ihe owner of this property to peNorm iho work tor which applicalion is made and I comr ry wtlh the <br /> Sta�e Conlractors Law i 8.27 CW and 296.200 WAC. <br /> � <br /> ��,hb�, c 8 �a►� ia. <br /> Signatur�---Ovmsr/ onlrac r/Authorizetl t Date <br /> ---� ., .. .. . .. <br /> __... . , � � ..�, b, <br />