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_ . _ � � <br /> PERMIT APPLICATION ° ��C�OML� I <br /> � <br /> CITY OF EVERETT PERMIT SERVICES FtH 0 g 2012 <br /> 3200 CEDAR STREET, EVERETT,WA 98201 I <br /> 425�•257-8810—FAX425-257-8857—www.everettwa.org PUBLIC WORKS <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 �,�' �Z <br /> SITE ADDRESS PARCEL TAX I.D.M PERMR� <br /> � �v�✓ rea,� 1�c�- �-C � � o� �oo o �2oz-oZc� <br /> LEGA LOT NO. BLO TAACT OR SUBDIVISION N <br /> DESC. <br /> OWNEH AO�flESS CITYZP PHONE <br /> TENANTNAME CONTACTFOHPERMIT P�E�D�j— � �I II <br /> ��� � I l��i�,_� E-MAIL f'�� ✓P�LtS(�NL ✓P•�1.j <br /> ,�J. � <br /> '�3Nfn7C �'�t�GG��Vv1 �5�5-G�" S�" .��fi'� �` 3-��"�"9�'��" <br /> COHTR.LICENSE#�����s�9��� wa �����r <br /> USE OF BUILDING HEAT SOURCE CO ACT PRICE OF WORK <br /> Eleciric Gas_Other �,���� <br /> — � <br /> �� �� � � <br /> �y��( 'D� 6 ' Ty/� � �X��•9r/��'�r syS� u///�la,,� UP��� <br /> PLUMBING MECHANICAL <br /> N TYPE OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> 'et _ A/C—air handling units <br /> Bat b _ Forced air systems <br /> _ Lavat (wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kilchen sin disposal _ Gas tireplace <br /> Dishwash�r _ Gasrange <br /> Clolhes washer Clothes dryer <br /> Waler heater � Range hood <br /> Sink(servicelbar/mo � Exhaust�an <br /> Backflow prevent _ Heat pump <br /> Urinal _ U�it heater <br /> _ Drinking F lain _ Boiler <br /> _ Floord� _ Refrigeration <br /> Greas�trap Woodstove <br /> oof drains Olher� dYa��`'� ,� <br /> — ther � —� ✓ C��f�,✓' <br /> � <br /> /.. <br /> CITY OF EVEHETT LOCAL SALES T4X CODE IS 3705 <br /> I hereby ceritify lhal I have read and examined lhis application and know the same to be lrue and correct. All provieions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher specilied herein or not The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other�late or local law regulaling construction or the performance of <br /> construction.Th am authorized by the owner of ltiis property to perfarm the work for which application is made and I comply with the <br /> State Contr� . RCW and 296200 WAC. � �� /� <br /> � ( <br /> 'Signature of Owner/ContractodAuthonzed Agent Dat � <br /> Z <br />