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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT,V'JA 98201 <br /> 425-257-8810—FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS '7���l� �r� ���(l„t PARCEL TAX I.D.N �RMIT i� <br /> �� 'U G�iL�'S A�ll,' �v` --� U�I - � • <br /> LEGA LOT NO. BLOCK 7RACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 'JK6'i�PL M�ST��L �,I� 2705 c��PYhJ� � 1,JP'- 425Z5�s�f� <br /> TENANT kAME CONTACT FOR PERMIT PNONE '�(� .3l�"rl- I���� <br /> �1L`� f�F�"(,/cv�(�C.-T1 � �� ���U�V� E�MAILM�I1.I�v2V"- �N�r <br /> ����� o,�����,��-r����G ,��;�u.-����s,�.��.s, �// m� w�qoi�� <br /> CONTR.UCENSE/ ��(��'�(a$ - D�07O <br /> QP-�Pta-Dy`��o W►-- <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecVic _Gas Other � �/v�� � � <br /> i ' <br /> WORK OESCRIPTION � ���P� I� _ !_« � � �� '1 '1�� � 1,1�U �}-�- �t�� <br /> ��� w�`� r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TURE OR IiEM NO. TYPE OF F�xTURE OR ITEM <br /> Toilet _ AIC-air handling units <br /> Bathtub _ ForCed air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler heater _ Range hood <br /> Sink(service/badmop/etc.) __ Exhaust fan <br /> BackBow preventer _ Heat pump <br /> Urinal _ Unil heater <br /> _ Drinking Founlain Boiler <br /> Floordrain _ Rehigerelion <br /> Grease trep _ Woodstove <br /> Roof drains _ Other <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> I hereby certify that I have read and examined tnis applicatlon and knaw the same to be true and correct. All provisions of laws and <br /> ordinances goveming this type of work will be cnmplied with whelher specified herein or nol. The grantlng of a permit dces nol presume <br /> to give aulhonty to violate or cancel the provision of any other slate or lucal lew regulating consWction or the perfortnance of <br /> consWdion.Thal I am authorized by the owner oi this property to peAorm the work for which appliralion is made and I comply with the <br /> State Contcadors L/�41827 RCW and 296.200 WAC. <br /> �2Gt'�Cl/�rc�.c��•*l'-- LL� ��j �/�I D <br /> Signa ure of Owner�tractoriAuthonzed Agent 'D�te <br /> � �� <br /> � <br />