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• / <br /> � • <br /> � - PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT',WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.X PE p <br /> � � � - � ,,�..�,/�l Gclrfi� a:,y�nz�n� i�7�,� �� D �,' -va`7 <br /> L GA LOT NO. BLOCK TRACT OR SUBDIVISION R <br /> DESC. <br /> OWNER ADDRESS CffY21P PF10NE <br /> .��AZ'n/; S�rfiR�i6r`��. <br /> TENANT NAME CONTACT FOR PER�XR PHONE 3� C��j- 3Jn� <br /> �l�f�'K/ 71.1N�'� I %aYNI-�1��� e-Ma� or+�i!TFS/�/Nl ,� <br /> Lc6RfAT�:Ta <br /> F/%��t S.cFP-�/✓c�,�%Nw ,,i ?7 y f g✓,��.e l,�rk� Ci��r Ti�-rN�✓��Z, vyls', <br /> CONTp.UCENSE# �^�k,f��J�,nG`+�;71 � <br /> i— ' .��' ��- 35�7 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �r�'%�/G'i?ri/'y�,/j/% _Electric _Gas_Olher �F�>>M <br /> MIORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Tuilel A/C—air handling units <br /> Batiitub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Waterheater Rangehood..—�/�" SySTE� ����" �� <br /> __ Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backllow prQvenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Foun�ain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Root drains Other <br /> Olher <br /> CITY OF EVEREIT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ce�itify thal I have read and examined this application and know the,same to be true and correct. AII provisions of laws and <br /> ordinaces governing�his lype of work will be complied wilh wliether specified herein or not.The grantinp of a permit does nol presume <br /> to give authorily to violale or cancel the provision of any olher state or local law regulating construction or the pertormance of <br /> construction.Thst I am authorized by the owner of lhis property to perlorm the work for which application is made and I compiy with the <br /> Stale Conir rs Law 182 RC .200 WAC. <br /> ,�-/7-� <br /> natu ne I n c o/Ab horize Agent Dale <br /> /2 <br />