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� PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERF'fT, WA 9820t <br /> 425-257-8810—FAX 425-257-8957—www.everettwa.o`g <br /> APPLICATIONS ARE ACCEPTED 1=ROM 8 AM TO 4 PM (.� �.� � —rJ� <br /> SITE ADDRESS PARCEL 7AX I.D.p PERMIT.�1 <br /> � 'f Z C.� AVL '�vl./ 3 �i i �4�'_GZk6c, � ,'� Y- �!%.`� <br /> LEGA LOT NO. BLOCK TRACT OR UBDIVISION R <br /> DESC. <br /> OWNER � . ADDpESS CITY2fP PHONE <br /> 1 N � <br /> �. �'� �. � �iv'tnr'� , ��l� /' � 1� . � �''_ '�l-I �._ ., � '� ��i�' � <br /> TENANTNAME . CONTACTFORPERMIT PMONE �: � t � G <br /> (V.t� a'��,t ( i.(�� I �Ac.�)•,.�. `�i �) � �t-C' <br /> i,� . l'��� .�,. �l.�r'Y'g��,�i- � <5��'' c11a � , <br /> �ti_F3�e-�,�a�7u�rb, x€�rrL.ru� n� -�, <br /> , I � <br /> {., , .�I'�' � �, ;i ...,it� . LTt? I ;;`> , ..i"- A�utS !, . .� �i, �t��I �S <br /> COt7TR.UCENSE# �L11 71 Z,7� ���� L� <br /> � , ;, :I ,�� 'i1f � L4 (: �' l <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � � � � Electric Gas Other � <�--�C.�"�� �.L l;' 3 �Q � <br /> WORK DESCRIPTION <br /> 1� IV-�� �iitin �;G �I��l P�nt�.s L• ;�i,-/ �� `»'�� C�1 <br /> �� �.,11�.�.�., �.�. <br /> ��,,;; <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUf1E OR�TEM N0. TVPE OF FI%TUR[OR ITEM <br /> Toile� NC-air handling units <br /> Bathtub Forced z:r systems <br /> Lavarory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> Clmhes washer Clothes dryer <br /> Waler heater . Range hood <br /> Sink (service-badmop�etc.) _ Ezhaust fan <br /> � Backllow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain 8oiler <br /> Floor drain Retrioeration <br /> Grease trap Woodstove <br /> Roof drains Otlier <br /> Other <br /> — ----- — — I <br /> CITV OF EVEHETT LOCAL SALES TA%CODL•IS 3f 05 � <br /> 1 hereby ceritify that 1 have read and examined this applicalion and know the same to be true and correcL ,41I p�ovisions ol laws and <br /> iordinaces govermng this type of work will be complied with whether specified herein or not.The grant�ng of a permit does not presume <br /> to give authority to violate or cancel ihe proviswn ot any other state or local law mgulating consirucbon or Ihe peAormance of <br /> constmction.That I am authorized by the ownei ol this property to peAorm Ihe work lor which applicat�on is made and I comply with the <br /> 3tate Conhactors Law.aB27 RCW and 296200 WAC. <br /> :'/ <br /> ' -� i� C �7 <br /> !��_. <br /> Signature ol.Owp�2f/Contractor/Authorized Agent Date / <br /> 1L <br />