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FEB-26—���9 13�43 P.02iO3 <br /> �. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET'�,WA 98201 <br /> A25-257-887 0—FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 2 ...a(�-� <br /> SITEAD�RESS PARCELTAXI.O.!! P MITX <br /> �Lo� �owlv� �� dD�IZtrao :Z0o3a� .S 9�.� - �l��� <br /> LEGA LOTNO. ! '/ BLOCK TRACTORSUU1ti'IVISIDNA / ..._!_� �L�C/^Q � B�UC.[� <br /> �ESC. 3 f..Nc� 'l 2 �0 1�.e. 1'7 i 1� +Qsf[� I� <br /> OWNER AOD(7E CITY2IP PHONE <br /> `� d 3 ��aL 12e�e� �bos �O�ie. AyE � �'ver��tl, k1�4 �2s-3aa-£� s <br /> a,�� <br /> 7ENANTNMIE COHTACTFORPERMIT /� y PHONE /�ZS'_ 205���'�], LI� <br /> N II�' �Q/.l id W �����L K�N'15 E-MAIL C�r0�G�(5 SiPG- CI <br /> � �1J, I,c), o�l�?S��j 312 log`"" Sas�J ��,�1� �2�'=�73 -(6 13 ,c <br /> eor+rn.ueeNse z Il��1"1-� 5 � 132 N l� - �g2D�{ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �--�Dyy�,� �Ieciric �Gas_Other ��� � <br /> WORK D[SCRIPTION <br /> �Qar a-F� 01 d �2..�v-�' a�� rn� 1a c� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUFiE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash bazin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 3 dispor� _ Gas fireplace <br /> � Dishwasher _ Gascan�e <br /> Clothas washer Cto�hes dryer <br /> Water hea�er Range hood <br /> Sink(servicelbadmopletcJ Exhaust fan <br /> Backtlow preventer _ Heat pump <br /> � Urinal Unil heater <br /> Drinkin9 Fountain _ Boiler <br /> Floor drain ____ Retrigera�ion <br /> Gresse Irap Woodstove <br /> Roaf drnins _ Other <br /> � Other _�, <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify tha[I have�ead and examined tnis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wi�h whethcr spedfied herein or nol.The granting ol a permit does not presume <br /> to g,ve authority to violate or cancel the provision of any other state or local law regulating construction or the pedormance ol <br /> construction.That 1 am aulhorized by the owner of Ihis property ro pedocm the work for which applieation is made and I comply with the <br /> State Con or�s/I,�)v 1827 R W and 296.200 VlAC. <br /> \C1-'�cA���6t�(�/s�� �'� Z Z� �� . <br /> re ot Owner/ ontraMar/Authonzed Apent Date <br /> �� _. _. <br />