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PEFiMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 e �a 6-D� <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM T04 PM �`I?S O6 ' I �I <br /> SREADDRESS GJ/}. /�`DI PARCELTAXI.D.7! PER R� <br /> ;Z�07-� �DGB A-✓E, �'VLZ�TT" ooy34/�o2SOo/o0 > ,�C)�� 00� <br /> LEGA LOiNO. BLOCK TflACTORSUODIVISIOHR <br /> DESC. /� �OzJ D 'O E✓ERE� PL�4T-' <br /> OWNEFi AD�RESS CRYldP PF10NE <br /> sKr� �-�.�.-.. mUNK�rL u.c� �.o.$ox 5�o� Ev�,zen- w a 9B 20� <br /> TENANT NAME CONTACT FOR PERMR PffONE �2��7Zy-S'-/S�j <br /> {�E.� '���r CL.IF� MIF-fM e-ua� G'�'1i/�rnP escO.c <br /> c rrrnn oR �'CUni(aELEGiRIGS1fiNCD. AOORES �S�SA- E.'r'bR+ui �T�'m��'DlnA NE�2S3�71Z-57$3 <br /> corrrH.uceNse• ��' � �"�� <br /> youn�G�s�¢10�- !� - a � - a � <br /> USE OF BUILDING HEAT SOUflCE CONTRACT PRICE OF WOflK <br /> C7��/CE _E�ectric _Gas_otner I � �//7.QC.7 <br /> WORKDESCRIPTION jik�i_K.yl� f� (/�SlNL.1_ �C IrJ1t�2J�9/�L1�� I;�.(,�l�ltitl/V/k�� <br /> t:�=-y wCi�> eti �cv-n-1 ��•sn c;�r- -PaRr�r��t. ���Di nGti.� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTl1RE OR ITEM N0. TYPE OF Fl7(T1JRE OR REM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Klchen sink&disposal Gas fireplaze <br /> Dishwazher Gas renge <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceibarlmop/etc.) C-xhaust fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Unnking Fountain �oiler <br /> Floor drai n RefrigeraGon <br /> Grease trap Woaktove <br /> Rool drans Other <br /> Other <br /> CfiV OF EVEfiETT LOCAL SALESTAX COOC IS 8105 <br /> I hereby ceritify that 1 have read and examined this applicaGon and hnow the same to ba We and correct. All provisions of laws and <br /> ordinaces goveming this type ol xrork Nill be complied vnth whether specified herein or noL The grarrting of a pertnit does nat presume <br /> to give authonty to violate or cancel the provision o(any other state or lopl law regulating conffiruction or the performance of <br /> construction.That I m authorized by the owner of this pmperty to perform the worn!orwhich application is made and I comply vrith the <br /> Slate ConVactors aw 18.27 RCW an 29G.200 NAC. <br /> � // , <br /> Signa 1 OwneqContradoqAuthonzed Agent Date / <br /> � L <br />