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t ' <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 /> g _ ai�o7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE�A,,�DRESS PARCEL TAX I.D.# PERMIT# <br /> 1f�'�-c.� - � � Gs, '� t� do� Do � o !h��a� - C 1 n <br /> LEGA LOT 0. BLOCK TRACT OR SUBDIVISION 1t <br /> DESC. L'j� . `yG , <br /> OWNER ADDRESS CITV�ZIP� PHONE <br /> �.v��a�LL'�.��err��.TZ�� �'�'� � �1t'b ��,�r �'���sl <br /> TENANT NAME CONTACT FOR PERMIT � PFiONE � ���L <br /> GL/1� LU I c,co � l,� �U � (�lJ�/� e�n�a� A 1 <br /> c r-�p�� �� /n►�� � � �j� 2� �T <br /> G`� ' PG, , � �G�99 ��3 <br /> CONTFI.LICE E# �/ �r �-y-.��' � - <br /> C d/Lf" <br /> USE OF BUILDING HEAT S URCE I ONTRACT PRICE OF WORK <br /> ��it'�! ,� _Electric _Gas_Other �2Q'� <br /> �'NY'C <br /> �/' i <br /> WORK//V'✓JnGL / TI G l (!%�Y�+� �—tCW"�f"N �°v�J� �L�IIL��? <br /> � � <br /> PLUM ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet A!C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposa� Gas fireplacc <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelbadmop/etc.) _ Fxha�si ian <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease tran � Woodstove,_ . ,. ,,/ ,.� �� <br /> Rooi drains Other � <br /> Other <br /> CITV OF EVERETT LOCAL SAlES TA%CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and corract. All provisions ol laN�s and <br /> ordinaces floverning this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhoriry ro violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> consiruction.That 1 am authorized by the owner o(ihis property to perlorm the work for which application is made and I comply with the <br /> S��te'Goniracior Law 7 RCW nd 296.200 �AC. <br /> / 7- z�>7 <br /> Sign u n r/ "n rac�or utho e g t Date <br /> ��� <br />